Provider Demographics
NPI:1861532624
Name:BUSKIRK, TRACY DELORES (CMA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:DELORES
Last Name:BUSKIRK
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 SE 174TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-9352
Mailing Address - Country:US
Mailing Address - Phone:503-661-7576
Mailing Address - Fax:503-761-0042
Practice Address - Street 1:14815 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-2336
Practice Address - Country:US
Practice Address - Phone:503-761-7139
Practice Address - Fax:503-761-0042
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide