MEDICARE: TRACI POELLNITZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	444	OTHER		INDEPENDENT PROVIDER

General Provider Information

NPI Number	:	1114514635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI POELLNITZ

Provider Business Mailing Address
First Line	:	3054 MENTOR ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1512
Country	:	US
Telephone Number	:	513-692-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3054 MENTOR ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1512
Country	:	US
Telephone Number	:	513-692-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	12/30/2020

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Directions to “ TRACI POELLNITZ ” Practice Location

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