Individual
LISA LUANNE TRACEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4033 N EARLY RIDGE RD NE, MCCONNELSVILLE, OH 43756-9730
(740) 509-0233
Mailing address
4033 N EARLY RIDGE RD NE, MCCONNELSVILLE, OH 43756-9730
(740) 509-0233
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6002310
DODD
OH
Enumeration date
09/30/2020
Last updated
09/30/2020
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