Provider Demographics
NPI:1861232027
Name:SAMPSON, TRACI
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:SAMPSON
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 1:8832 SPIETH RD
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44253-9743
Mailing Address - Country:US
Mailing Address - Phone:216-233-6467
Mailing Address - Fax:
Practice Address - Street 1:8832 SPIETH RD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44253-9743
Practice Address - Country:US
Practice Address - Phone:216-233-6467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion