Provider Demographics
NPI:1902350721
Name:PARENT, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:PARENT
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 1:15196 LARSEN AVE
Mailing Address - Street 2:
Mailing Address - City:GOWEN
Mailing Address - State:MI
Mailing Address - Zip Code:49326-9701
Mailing Address - Country:US
Mailing Address - Phone:616-301-5571
Mailing Address - Fax:
Practice Address - Street 1:15196 LARSEN AVE
Practice Address - Street 2:
Practice Address - City:GOWEN
Practice Address - State:MI
Practice Address - Zip Code:49326-9701
Practice Address - Country:US
Practice Address - Phone:616-301-5571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other