Provider Demographics
NPI:1285400028
Name:TRACZYK, JUSTINE NICOLE
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:NICOLE
Last Name:TRACZYK
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 1:706 BROOKLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2710
Mailing Address - Country:US
Mailing Address - Phone:330-350-2437
Mailing Address - Fax:
Practice Address - Street 1:4389 MEDINA RD
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-1388
Practice Address - Country:US
Practice Address - Phone:234-815-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide