Healthcare Provider Details

I. General information

NPI: 1780731125
Provider Name (Legal Business Name): TRACI MARIE CORDA R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11484 B AVE
AUBURN CA
95603-2603
US

IV. Provider business mailing address

11893 PROSPECT HILL DR
GOLD RIVER CA
95670-8250
US

V. Phone/Fax

Practice location:
  • Phone: 530-886-3633
  • Fax:
Mailing address:
  • Phone: 530-886-3633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number352570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: