Doctor Name: | TRACY PATNOUDE |
NPI Number: | 1336500578 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN |
License Number: | 4704293378 |
Business Practice Address: | 960 M 60 E Cassopolis, MI - 490319339 |
Business Phone Number: | 2692285110 |
Business Fax Number: | |
Mailing Address: | 21767 Pinhook Rd, MENDON |
State: | MI |
Postal Code: | 490728732 |
Phone Number: | 2695060844 |
Fax Number: | |
NPI Enumeration Date: | 03/16/2016 |
NPI Last Update Date: | 03/16/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WP0808X |
License Number: | 4704293378 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |