Provider Demographics
NPI:1962246660
Name:TRAYLOR, TRACY (RN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:TRAYLOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4213 MCGREGOR AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44105-3227
Mailing Address - Country:US
Mailing Address - Phone:216-322-9747
Mailing Address - Fax:
Practice Address - Street 1:4213 MCGREGOR AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH HTS
Practice Address - State:OH
Practice Address - Zip Code:44105-3227
Practice Address - Country:US
Practice Address - Phone:216-322-9747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.459782163WA0400X, 163WC2100X, 163W00000X
171400000X, 177F00000X, 251C00000X, 343900000X, 347C00000X, 372500000X, 372600000X, 374T00000X, 376J00000X, 385H00000X, 385HR2060X, 385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No171400000XOther Service ProvidersHealth & Wellness Coach
No177F00000XOther Service ProvidersLodging
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child