Healthcare Provider Details

I. General information

NPI: 1144592478
Provider Name (Legal Business Name): TRACY S. MEYER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PORTER AVE
BUFFALO NY
14201-1032
US

IV. Provider business mailing address

320 PORTER AVE
BUFFALO NY
14201-1032
US

V. Phone/Fax

Practice location:
  • Phone: 716-816-4382
  • Fax: 716-816-4389
Mailing address:
  • Phone: 716-816-4382
  • Fax: 716-816-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number424430-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: