Provider Demographics
NPI:1780475251
Name:PALLADINO, TRACEY ANN
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:ANN
Last Name:PALLADINO
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 1:5068 S 106TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-2149
Mailing Address - Country:US
Mailing Address - Phone:402-215-7561
Mailing Address - Fax:
Practice Address - Street 1:3202 S 73RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3516
Practice Address - Country:US
Practice Address - Phone:402-215-7561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant