Provider Demographics
NPI:1265718043
Name:TRACIE TAYLOR NURSING
Entity type:Organization
Organization Name:TRACIE TAYLOR NURSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-453-2116
Mailing Address - Street 1:3112 SURF AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1545
Mailing Address - Country:US
Mailing Address - Phone:440-453-2116
Mailing Address - Fax:
Practice Address - Street 1:3112 SURF AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1545
Practice Address - Country:US
Practice Address - Phone:440-453-2116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health