Provider Demographics
NPI:1922864438
Name:WEILLS, TRACI MARIE
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:MARIE
Last Name:WEILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:PIONEER
Mailing Address - State:OH
Mailing Address - Zip Code:43554-0017
Mailing Address - Country:US
Mailing Address - Phone:419-551-2626
Mailing Address - Fax:
Practice Address - Street 1:309 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:PIONEER
Practice Address - State:OH
Practice Address - Zip Code:43554-7839
Practice Address - Country:US
Practice Address - Phone:419-551-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide