Provider Demographics
NPI:1508020777
Name:DILLINGHAM, TRACY (CNP / CNM)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:DILLINGHAM
Suffix:
Gender:F
Credentials:CNP / CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 AUBURN AVENUE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:513-721-7635
Mailing Address - Fax:513-721-2313
Practice Address - Street 1:2314 AUBURN AVENUE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-287-6484
Practice Address - Fax:513-287-6580
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM-11023367A00000X
OHCOA.13917-NP363LF0000X
OHCOA.10023-NM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2877963Medicaid