Provider Demographics
NPI:1942565098
Name:VINSON, TRACY MARIA
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:MARIA
Last Name:VINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:MARIA
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1550 W 122ND PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-5301
Mailing Address - Country:US
Mailing Address - Phone:773-983-4626
Mailing Address - Fax:
Practice Address - Street 1:1550 W 122ND PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-5301
Practice Address - Country:US
Practice Address - Phone:773-983-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041330108163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse