Healthcare Provider Details

I. General information

NPI: 1629989983
Provider Name (Legal Business Name): TRACY L TREGILLIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W SAGOLA AVE
KINGSFORD MI
49802-5155
US

IV. Provider business mailing address

2020 W SAGOLA AVE
KINGSFORD MI
49802-5155
US

V. Phone/Fax

Practice location:
  • Phone: 906-221-1146
  • Fax:
Mailing address:
  • Phone: 906-221-1146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704304865
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: