Healthcare Provider Details

I. General information

NPI: 1760840714
Provider Name (Legal Business Name): TRACEY BILLINGS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 S. BAYLEY HAZEN RD
RYEGATE VT
05042
US

IV. Provider business mailing address

318 US ROUTE 2B
SAINT JOHNSBURY VT
05819-9199
US

V. Phone/Fax

Practice location:
  • Phone: 802-584-4679
  • Fax:
Mailing address:
  • Phone: 802-535-6315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number026-0035068
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: