Provider Demographics
NPI:1700931516
Name:SAUNDERS, TRACY L (NP-C)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43401 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1961
Mailing Address - Country:US
Mailing Address - Phone:586-488-3636
Mailing Address - Fax:586-488-3635
Practice Address - Street 1:43401 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1961
Practice Address - Country:US
Practice Address - Phone:586-488-3636
Practice Address - Fax:586-488-3635
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704396919163W00000X
MI4704196919363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704196919OtherNURSE PRACTITIONER