Provider Demographics
NPI:1487191011
Name:WEBSTER, TRACY M (RN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:M
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:M
Other - Last Name:CZECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 QUADE ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-2725
Mailing Address - Country:US
Mailing Address - Phone:518-793-3418
Mailing Address - Fax:518-793-4888
Practice Address - Street 1:20 QUADE ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2725
Practice Address - Country:US
Practice Address - Phone:518-793-3418
Practice Address - Fax:518-793-4888
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY663972163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool