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General NPI Number Information
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NPI Number | 1639768138
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Entity Type | Individual
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Provider Name | TRACEY LHERISSON WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/11/2021
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Last Update Date | 08/07/2022
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Provider Practice Location Address
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Address Line | 522 3RD ST
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City | BROOKLYN
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State | NY
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Zip | 11215-3003
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Country | US
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Telephone | 718-768-8500
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Fax | 718-832-2523
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Provider Business Mailing Address
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Address Line | 522 3RD ST
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City | BROOKLYN
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State | NY
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Zip | 11215-3003
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Country | US
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Telephone | 718-768-8500
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Fax | 718-832-2523
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | F421049-01
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License Number State | NY
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