Provider Demographics
NPI:1114748084
Name:GAWKOWSKI, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:GAWKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15425 HUBBARD ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3147
Mailing Address - Country:US
Mailing Address - Phone:734-516-0947
Mailing Address - Fax:
Practice Address - Street 1:15425 HUBBARD ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3147
Practice Address - Country:US
Practice Address - Phone:734-516-0947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704341241163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health