Provider Demographics
NPI:1750695169
Name:PATTISON, TRACY LEE (LPN)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LEE
Last Name:PATTISON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LEE
Other - Last Name:ARMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:761 PARSELLS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609
Mailing Address - Country:US
Mailing Address - Phone:585-478-7398
Mailing Address - Fax:
Practice Address - Street 1:989 BLOSSOM ROAD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610
Practice Address - Country:US
Practice Address - Phone:585-482-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238157-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse