Provider Demographics
NPI:1477377984
Name:MOHRMANN, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MOHRMANN
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 1:19 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1234
Practice Address - Country:US
Practice Address - Phone:845-337-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY542350163WX1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX1500XNursing Service ProvidersRegistered NurseOstomy Care