Basic Information
| Provider Information | |||||||||
| NPI: | 1821563693 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAUN | ||||||||
| FirstName: | TRACEY | ||||||||
| MiddleName: | IRENE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | C.N.A. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CRONAN | ||||||||
| OtherFirstName: | TRACEY | ||||||||
| OtherMiddleName: | IRENE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1923 SULPHUR SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | MORRISTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378135654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233179344 | ||||||||
| FaxNumber: | 4237142355 | ||||||||
| Practice Location | |||||||||
| Address1: | 3360 HIGHWAY 411 N | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373295276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238875131 | ||||||||
| FaxNumber: | 4238875917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2018 | ||||||||
| LastUpdateDate: | 10/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 376K00000X | 148559 | TN | Y | Nursing Service Related Providers | Nurse's Aide |
No ID Information.