Provider Demographics
NPI:1336431048
Name:SUDLER, TRACY IRIS (LVN)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:IRIS
Last Name:SUDLER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8226 WESTPORT CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-5547
Mailing Address - Country:US
Mailing Address - Phone:916-470-2723
Mailing Address - Fax:
Practice Address - Street 1:8226 WESTPORT CIR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-5547
Practice Address - Country:US
Practice Address - Phone:916-470-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 149034164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse