Provider Demographics
NPI:1902547359
Name:FOSSIER, TRACEE LYNN (LVN)
Entity Type:Individual
Prefix:
First Name:TRACEE
Middle Name:LYNN
Last Name:FOSSIER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15510 DOWNFORD DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-8680
Mailing Address - Country:US
Mailing Address - Phone:713-542-6022
Mailing Address - Fax:
Practice Address - Street 1:15510 DOWNFORD DR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-8680
Practice Address - Country:US
Practice Address - Phone:713-542-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171400000X
TX168211164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No171400000XOther Service ProvidersHealth & Wellness Coach