MEDICARE: MS. TRACEY J BRADY CNA

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	376K00000X	Nurse's Aide	342551080507R	NY

General Provider Information

NPI Number	:	1659569275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACEY J BRADY CNA

Provider Business Mailing Address
First Line	:	107 MEADOW LN
Second Line	:
City	:	SOUTH NEW BERLIN
State	:	NY
Zip	:	13843-2260
Country	:	US
Telephone Number	:	607-334-4228
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 MEADOW LN
Second Line	:
City	:	SOUTH NEW BERLIN
State	:	NY
Zip	:	13843-2260
Country	:	US
Telephone Number	:	607-334-4228
Fax Number	:

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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