Healthcare Provider Details

I. General information

NPI: 1346399250
Provider Name (Legal Business Name): TRACY COREY RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 4TH AVE SW
SEATTLE WA
98106-2153
US

IV. Provider business mailing address

PO BOX 47163
SEATTLE WA
98146-7163
US

V. Phone/Fax

Practice location:
  • Phone: 206-763-2733
  • Fax: 206-762-0746
Mailing address:
  • Phone: 206-819-4575
  • Fax: 206-762-0746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN00095694
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: