Healthcare Provider Details

I. General information

NPI: 1083565766
Provider Name (Legal Business Name): TRACY RENEE BELANGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2026
Last Update Date: 02/07/2026
Certification Date: 02/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 CHURCH ST N
CONCORD NC
28025-2927
US

IV. Provider business mailing address

920 CHURCH ST N
CONCORD NC
28025-2927
US

V. Phone/Fax

Practice location:
  • Phone: 336-470-8641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number161579
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: