Provider Demographics
NPI:1548522600
Name:CREDEUR, TRACEY D (RN)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:D
Last Name:CREDEUR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-3227
Mailing Address - Country:US
Mailing Address - Phone:337-788-7507
Mailing Address - Fax:337-788-7577
Practice Address - Street 1:1029 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-5509
Practice Address - Country:US
Practice Address - Phone:337-788-7507
Practice Address - Fax:337-788-7577
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN094855163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health