Provider Demographics
NPI:1134842289
Name:SCHUTA, TRACY M (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:M
Last Name:SCHUTA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3979 OCKLER AVE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4435
Mailing Address - Country:US
Mailing Address - Phone:716-602-9901
Mailing Address - Fax:
Practice Address - Street 1:95 JOHN MUIR DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-1144
Practice Address - Country:US
Practice Address - Phone:716-541-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY680345163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool