Provider Demographics
NPI:1316282221
Name:TRACY, DAWN M (RN)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:M
Last Name:TRACY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:818 N GREECE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-1077
Mailing Address - Country:US
Mailing Address - Phone:585-857-1723
Mailing Address - Fax:
Practice Address - Street 1:818 N GREECE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-1077
Practice Address - Country:US
Practice Address - Phone:585-857-1723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY611289163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY611289OtherRN