Healthcare Provider Details

I. General information

NPI: 1306751698
Provider Name (Legal Business Name): TRACY LYNNE CORDONNIER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 MARKER RD
VERSAILLES OH
45380-9494
US

IV. Provider business mailing address

7374 BEAMSVILLE WEBSTER RD
VERSAILLES OH
45380-9519
US

V. Phone/Fax

Practice location:
  • Phone: 937-526-4426
  • Fax:
Mailing address:
  • Phone: 937-417-4617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number251730
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: