Healthcare Provider Details

I. General information

NPI: 1386033710
Provider Name (Legal Business Name): TRACEY WESSELL R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11239 FULL MOON LN
LINCOLN DE
19960-4085
US

IV. Provider business mailing address

11239 FULL MOON LN
LINCOLN DE
19960-4085
US

V. Phone/Fax

Practice location:
  • Phone: 302-465-6093
  • Fax:
Mailing address:
  • Phone: 302-465-6093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0021000
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: