Provider Demographics
NPI:1881284156
Name:STONAKER, TRACY J
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:J
Last Name:STONAKER
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 1:3000 N SHERIDAN RD APT 14A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5584
Mailing Address - Country:US
Mailing Address - Phone:312-330-1413
Mailing Address - Fax:
Practice Address - Street 1:3000 N SHERIDAN RD APT 14A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5584
Practice Address - Country:US
Practice Address - Phone:312-330-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program