Provider Demographics
NPI:1255137964
Name:TRAVER, TRACEY -LYN IRENE (RN)
Entity type:Individual
Prefix:
First Name:TRACEY -LYN
Middle Name:IRENE
Last Name:TRAVER
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SHEP CT
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-2100
Mailing Address - Country:US
Mailing Address - Phone:916-276-1387
Mailing Address - Fax:
Practice Address - Street 1:6 SHEP CT
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-2100
Practice Address - Country:US
Practice Address - Phone:916-276-1387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA592213163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory