Individual
TRACY PACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2300 N EDWARD ST, DECATUR, IL 62526-4163
(217) 876-4200
(217) 876-4209
Mailing address
2300 N EDWARD ST, DECATUR, IL 62526-4163
(217) 876-4200
(217) 876-4209
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209018658
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041413617
RN
IL
Enumeration date
08/21/2019
Last updated
11/19/2025
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