Healthcare Provider Details

I. General information

NPI: 1316282221
Provider Name (Legal Business Name): DAWN M TRACY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. DAWN M FOX

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 N GREECE RD
ROCHESTER NY
14626-1077
US

IV. Provider business mailing address

818 N GREECE RD
ROCHESTER NY
14626-1077
US

V. Phone/Fax

Practice location:
  • Phone: 585-857-1723
  • Fax:
Mailing address:
  • Phone: 585-857-1723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number611289
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: