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General NPI Number Information
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NPI Number | 1669292132
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Entity Type | Individual
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Provider Name | TRACI MICHELL ALLEN RN
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Gender | Female
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 101 BODIN CIR
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City | FAIRFIELD
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State | CA
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Zip | 94535-1809
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Country | US
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Telephone | 707-423-7331
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Fax |
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Provider Business Mailing Address
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Address Line | 550 WIEGAND WAY
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City | DIXON
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State | CA
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Zip | 95620-4522
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Country | US
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Telephone | 850-826-1136
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Fax |
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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 | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 9228192
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License Number State | FL
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