Provider Demographics
NPI:1669189189
Name:ASBERRY, TRACIE ELAINE
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:ELAINE
Last Name:ASBERRY
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 1:860 MALLISON AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1858
Mailing Address - Country:US
Mailing Address - Phone:330-598-4588
Mailing Address - Fax:
Practice Address - Street 1:860 MALLISON AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-1858
Practice Address - Country:US
Practice Address - Phone:330-598-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker