Individual
LUANN MARIE TRACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1708 HIGH ST, SOUTH BEND, IN 46613-2633
(574) 647-1400
(574) 647-5128
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71003603A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000714838
ANTHEM
IN
01
—
000000714843
ANTHEM
IN
01
—
000000789433
ANTHEM
IN
05
—
201024030
—
IN
Enumeration date
04/13/2011
Last updated
06/16/2016
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