Provider Demographics
NPI:1770706418
Name:DUNHAM, TRACY ROBIN
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ROBIN
Last Name:DUNHAM
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 1:4342 SAINT DOMINIC DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-5821
Mailing Address - Country:US
Mailing Address - Phone:513-257-4221
Mailing Address - Fax:
Practice Address - Street 1:4342 SAINT DOMINIC DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-5821
Practice Address - Country:US
Practice Address - Phone:513-257-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide