Provider Demographics
NPI:1154570893
Name:WELBORN, TRACEY SCOTT (RN)
Entity type:Individual
Prefix:MR
First Name:TRACEY
Middle Name:SCOTT
Last Name:WELBORN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10316 ASHBURN RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-2604
Mailing Address - Country:US
Mailing Address - Phone:804-272-7097
Mailing Address - Fax:
Practice Address - Street 1:10316 ASHBURN RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-2604
Practice Address - Country:US
Practice Address - Phone:804-272-7097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001214226163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical