Provider Demographics
NPI:1477309839
Name:LINDSEY, TRACIE LYNN
Entity type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:LYNN
Last Name:LINDSEY
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 1:63816 BANCROFT RD
Mailing Address - Street 2:
Mailing Address - City:MC ARTHUR
Mailing Address - State:OH
Mailing Address - Zip Code:45651-8002
Mailing Address - Country:US
Mailing Address - Phone:740-710-8554
Mailing Address - Fax:
Practice Address - Street 1:63816 BANCROFT RD
Practice Address - Street 2:
Practice Address - City:MC ARTHUR
Practice Address - State:OH
Practice Address - Zip Code:45651-8002
Practice Address - Country:US
Practice Address - Phone:740-710-8554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant