Provider Demographics
NPI:1255396834
Name:SARADUKE, TRACY JANE (RN, LICAC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:JANE
Last Name:SARADUKE
Suffix:
Gender:F
Credentials:RN, LICAC
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Mailing Address - Street 1:3082 EVERGREEN PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7968
Mailing Address - Country:US
Mailing Address - Phone:303-670-9181
Mailing Address - Fax:
Practice Address - Street 1:3082 EVERGREEN PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7968
Practice Address - Country:US
Practice Address - Phone:303-670-9181
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO98478163W00000X
CO0340171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered171100000XOther Service ProvidersAcupuncturist