Provider Demographics
NPI:1356944946
Name:JAMISON, TRACY M
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:M
Last Name:JAMISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31700 WINNEMAC RD
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43344-9740
Mailing Address - Country:US
Mailing Address - Phone:740-943-5339
Mailing Address - Fax:
Practice Address - Street 1:31700 WINNEMAC RD
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43344-9740
Practice Address - Country:US
Practice Address - Phone:740-943-5339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant