MEDICARE: TRACY TRAYLOR RN

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	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	RN.459782	OH
2	163WC2100X	Continence Care Registered Nurse	RN.459782	OH
3	171400000X	Health & Wellness Coach
4	177F00000X	Lodging Provider
5	251C00000X	Developmentally Disabled Services Day Training Agency
6	343900000X	Non-emergency Medical Transport (VAN)
7	347C00000X	Private Vehicle
8	372500000X	Chore Provider
9	372600000X	Adult Companion
10	374T00000X	Religious Nonmedical Nursing Personnel
11	376J00000X	Homemaker
12	385H00000X	Respite Care
13	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
14	385HR2065X	Child Physical Disabilities Respite Care
15	163W00000X	Registered Nurse	RN.459782	OH

General Provider Information

NPI Number	:	1962246660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY TRAYLOR RN

Provider Business Mailing Address
First Line	:	4213 MCGREGOR AVE
Second Line	:
City	:	NEWBURGH HTS
State	:	OH
Zip	:	44105-3227
Country	:	US
Telephone Number	:	216-322-9747
Fax Number	:

Provider Business Practice Location Address
First Line	:	4213 MCGREGOR AVE
Second Line	:
City	:	NEWBURGH HTS
State	:	OH
Zip	:	44105-3227
Country	:	US
Telephone Number	:	216-322-9747
Fax Number	:

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

Provider Enumeration Date	:	06/19/2024
Last Update Date	:	06/27/2024

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