Provider Demographics
NPI:1992420285
Name:NOBEL, TRACEY LYNN
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:NOBEL
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 1:3925 HENDRON RD
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-9465
Mailing Address - Country:US
Mailing Address - Phone:614-966-1085
Mailing Address - Fax:
Practice Address - Street 1:3925 HENDRON RD
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-9465
Practice Address - Country:US
Practice Address - Phone:614-966-1085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant