Provider Demographics
NPI:1902588825
Name:DEWEY, TRACEY M
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:M
Last Name:DEWEY
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 1:64 MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3701
Mailing Address - Country:US
Mailing Address - Phone:603-283-1574
Mailing Address - Fax:
Practice Address - Street 1:32 EMERALD ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3601
Practice Address - Country:US
Practice Address - Phone:160-335-2664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist