Healthcare Provider Details

I. General information

NPI: 1093949356
Provider Name (Legal Business Name): TRACY J CAHON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7746 HAMILTON ST
WILLIAMSON NY
14589-9513
US

IV. Provider business mailing address

7764 HAMILTON ST
WILLIAMSON NY
14589-9513
US

V. Phone/Fax

Practice location:
  • Phone: 315-589-3025
  • Fax:
Mailing address:
  • Phone: 315-589-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number237913
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: