Healthcare Provider Details

I. General information

NPI: 1942632898
Provider Name (Legal Business Name): TRACY LEE SOKOLOSKI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MADISON AVE
SCRANTON PA
18510-2401
US

IV. Provider business mailing address

501 MADISON AVE
SCRANTON PA
18510-2401
US

V. Phone/Fax

Practice location:
  • Phone: 570-343-2383
  • Fax: 570-343-3923
Mailing address:
  • Phone: 570-343-2383
  • Fax: 570-343-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP013170
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN578153
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: