Healthcare Provider Details

I. General information

NPI: 1255629648
Provider Name (Legal Business Name): TRACY WARNER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 WEHRLE DR SUITE 1
WILLIAMSVILLE NY
14221-7034
US

IV. Provider business mailing address

4835 TUSCARORA RD
NIAGARA FALLS NY
14304-1163
US

V. Phone/Fax

Practice location:
  • Phone: 716-276-2123
  • Fax: 716-276-2129
Mailing address:
  • Phone: 702-845-6012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number198058
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: