Provider Demographics
NPI:1962830489
Name:RANSOME, TRACEY
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:
Last Name:RANSOME
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 1:4155 ESSEN LN APT 22
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2141
Mailing Address - Country:US
Mailing Address - Phone:215-850-8779
Mailing Address - Fax:225-387-0322
Practice Address - Street 1:4328 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5813
Practice Address - Country:US
Practice Address - Phone:225-387-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA85341123174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist