Provider Demographics
NPI:1811449184
Name:ROBISON, TRACI (RN)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:ROBISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 COUNTRY CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-3522
Mailing Address - Country:US
Mailing Address - Phone:814-865-6408
Mailing Address - Fax:
Practice Address - Street 1:44 COUNTRY CLUB CIR
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-3522
Practice Address - Country:US
Practice Address - Phone:814-865-6408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN510183L163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health