Provider Demographics
NPI:1205604717
Name:CROTHERS, TRACI HELLMER (LPN)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:HELLMER
Last Name:CROTHERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:HELLMER
Other - Last Name:ROEDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1220 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4651
Mailing Address - Country:US
Mailing Address - Phone:785-342-2690
Mailing Address - Fax:
Practice Address - Street 1:4200 6TH AVE SE STE 201
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1042
Practice Address - Country:US
Practice Address - Phone:360-459-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS23-36178-071164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse