Provider Demographics
NPI:1952699811
Name:KREIPE, TRACEY (RN, BSN, MPA)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:KREIPE
Suffix:
Gender:F
Credentials:RN, BSN, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:GILLESPIE
Mailing Address - State:IL
Mailing Address - Zip Code:62033-1473
Mailing Address - Country:US
Mailing Address - Phone:217-839-1526
Mailing Address - Fax:217-839-1538
Practice Address - Street 1:109 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:GILLESPIE
Practice Address - State:IL
Practice Address - Zip Code:62033-1473
Practice Address - Country:US
Practice Address - Phone:217-839-1526
Practice Address - Fax:217-839-1538
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041310479163WC1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health