Provider Demographics
NPI:1982469623
Name:EAST, TRACI LEE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LEE
Last Name:EAST
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9180
Mailing Address - Country:US
Mailing Address - Phone:419-996-5030
Mailing Address - Fax:419-996-5458
Practice Address - Street 1:1800 E 5TH ST
Practice Address - Street 2:
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-9180
Practice Address - Country:US
Practice Address - Phone:419-996-5030
Practice Address - Fax:419-996-5458
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0035835363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily