Provider Demographics
NPI:1013744259
Name:NEESE, TRACI
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:NEESE
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 1:160 OLD SAW MILL RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:WV
Mailing Address - Zip Code:26374-9751
Mailing Address - Country:US
Mailing Address - Phone:681-668-6420
Mailing Address - Fax:
Practice Address - Street 1:160 OLD SAW MILL RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:WV
Practice Address - Zip Code:26374-9751
Practice Address - Country:US
Practice Address - Phone:681-668-6420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide