Healthcare Provider Details

I. General information

NPI: 1023958816
Provider Name (Legal Business Name): TRACIE A COOLEY RN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3338 E MAIN STREET RD
ATTICA NY
14011-9684
US

IV. Provider business mailing address

3338 E MAIN STREET RD
ATTICA NY
14011-9684
US

V. Phone/Fax

Practice location:
  • Phone: 585-591-0400
  • Fax: 585-591-4561
Mailing address:
  • Phone: 585-591-0400
  • Fax: 585-591-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number592625-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: