Provider Demographics
NPI:1184445264
Name:BOSANKO, TRACY (PMHNP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:BOSANKO
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:SCHLEIF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5842 HATHAWAY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5609
Mailing Address - Country:US
Mailing Address - Phone:734-536-3043
Mailing Address - Fax:
Practice Address - Street 1:17177 N LAUREL PARK DR STE 131
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3952
Practice Address - Country:US
Practice Address - Phone:734-462-3210
Practice Address - Fax:734-462-1024
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704329968163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult