Provider Demographics
NPI:1063211985
Name:RUE, TRACI LYNN
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNN
Last Name:RUE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6418 S 179TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-2895
Mailing Address - Country:US
Mailing Address - Phone:402-850-7967
Mailing Address - Fax:
Practice Address - Street 1:6418 S 179TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-2895
Practice Address - Country:US
Practice Address - Phone:402-850-7967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X
NE372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider