Healthcare Provider Details

I. General information

NPI: 1619368214
Provider Name (Legal Business Name): TRACEY BROWAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12219 WILLIAMS RD
HOMERVILLE OH
44235-9545
US

IV. Provider business mailing address

12229 WILLIAMS RD
HOMERVILLE OH
44235
US

V. Phone/Fax

Practice location:
  • Phone: 330-416-6953
  • Fax:
Mailing address:
  • Phone: 330-416-6953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.137282-M-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: