Provider Demographics
NPI:1801593900
Name:WHEATLEY, TRACEY
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:WHEATLEY
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 1:22 N MULBERRY ST STE 120
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-4870
Mailing Address - Country:US
Mailing Address - Phone:240-500-9828
Mailing Address - Fax:
Practice Address - Street 1:22 N MULBERRY ST STE 120
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4870
Practice Address - Country:US
Practice Address - Phone:240-500-9828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management