MEDICARE: TRACIE LEE-STINGLEY LPN

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	164W00000X	Licensed Practical Nurse	PN.118995MEDS	OH

General Provider Information

NPI Number	:	1528334968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACIE LEE-STINGLEY LPN

Provider Business Mailing Address
First Line	:	2000 LEE RD
Second Line	:	414
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-3223
Country	:	US
Telephone Number	:	261-773-7730
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 LEE RD # 414
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2572
Country	:	US
Telephone Number	:	261-773-7730
Fax Number	:

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

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	07/29/2022

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