Provider Demographics
NPI:1427634609
Name:GILLMAN, TRACY L
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:GILLMAN
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 1:128 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45176-1005
Mailing Address - Country:US
Mailing Address - Phone:513-767-2734
Mailing Address - Fax:
Practice Address - Street 1:128 S 6TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:OH
Practice Address - Zip Code:45176-1005
Practice Address - Country:US
Practice Address - Phone:513-767-2734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker