Healthcare Provider Details

I. General information

NPI: 1548170707
Provider Name (Legal Business Name): TRACY ANN SHEEFEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11123 PARKVIEW PLAZA DR STE 106
FORT WAYNE IN
46845-1707
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR STE 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-672-6550
  • Fax:
Mailing address:
  • Phone: 260-266-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number28153364A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: