Provider Demographics
NPI:1902534878
Name:OLSEN-DOWNEY, TRACY NICOLE ANASTASIA (RN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:NICOLE ANASTASIA
Last Name:OLSEN-DOWNEY
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 1:197 SASSAFRAS ST
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:21651-2055
Mailing Address - Country:US
Mailing Address - Phone:484-568-3436
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:197 SASSAFRAS ST
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:MD
Practice Address - Zip Code:21651-2055
Practice Address - Country:US
Practice Address - Phone:484-568-3436
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR180370163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency