Provider Demographics
NPI:1366296899
Name:ORR, TRACEY M
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:M
Last Name:ORR
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 1:700 COURT ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4251
Mailing Address - Country:US
Mailing Address - Phone:989-770-0656
Mailing Address - Fax:
Practice Address - Street 1:700 COURT ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4251
Practice Address - Country:US
Practice Address - Phone:989-770-0656
Practice Address - Fax:833-448-3229
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20241054Medicaid