Healthcare Provider Details

I. General information

NPI: 1609142504
Provider Name (Legal Business Name): BARBARA S TRACY MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 HIGH ST
LEE MA
01238-1633
US

IV. Provider business mailing address

110 MANDALAY RD
LEE MA
01238-9455
US

V. Phone/Fax

Practice location:
  • Phone: 413-243-1122
  • Fax:
Mailing address:
  • Phone: 413-243-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN178475
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: