Provider Demographics
NPI:1932463783
Name:MERCHANT, TRACY LYN (LPN)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LYN
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LYN
Other - Last Name:BAYLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 CHELSEA PL
Mailing Address - Street 2:APT 3
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-1529
Mailing Address - Country:US
Mailing Address - Phone:518-932-6496
Mailing Address - Fax:
Practice Address - Street 1:6 CHELSEA PL
Practice Address - Street 2:APT 3
Practice Address - City:GANSEVOORT
Practice Address - State:NY
Practice Address - Zip Code:12831-1529
Practice Address - Country:US
Practice Address - Phone:518-932-6496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284297-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse