Healthcare Provider Details

I. General information

NPI: 1144819822
Provider Name (Legal Business Name): TRACY EYRE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRACY EYRE RN

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 S ELAM AVE
GREENSBORO NC
27403-2161
US

IV. Provider business mailing address

719 S ELAM AVE
GREENSBORO NC
27403-2161
US

V. Phone/Fax

Practice location:
  • Phone: 336-340-3453
  • Fax:
Mailing address:
  • Phone: 336-340-3453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number159288
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: