Provider Demographics
NPI:1861961799
Name:MCCONNELL, TRACEY
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:MCCONNELL
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 1:147 MARINE DR APT 9D
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-4211
Mailing Address - Country:US
Mailing Address - Phone:908-444-0603
Mailing Address - Fax:
Practice Address - Street 1:147 MARINE DR APT 9D
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-4211
Practice Address - Country:US
Practice Address - Phone:908-444-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula