MEDICARE: MRS. TRACY SHANNON DANKO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	10066073	PA

General Provider Information

NPI Number	:	1255803995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACY SHANNON DANKO

Provider Business Mailing Address
First Line	:	9243 ANDOVER RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-3818
Country	:	US
Telephone Number	:	267-359-9903
Fax Number	:

Provider Business Practice Location Address
First Line	:	9243 ANDOVER RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-3818
Country	:	US
Telephone Number	:	267-359-9903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2018
Last Update Date	:	12/19/2018

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