Provider Demographics
NPI:1780422238
Name:FLANNER, TRACI L
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:L
Last Name:FLANNER
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 1:224 REIMER DR
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-2128
Mailing Address - Country:US
Mailing Address - Phone:616-204-3179
Mailing Address - Fax:
Practice Address - Street 1:224 REIMER DR
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-2128
Practice Address - Country:US
Practice Address - Phone:616-204-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula