Provider Demographics
NPI:1043935612
Name:UNRUE, TRACEY M
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:M
Last Name:UNRUE
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 1:1146 SAWYER AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-1130
Mailing Address - Country:US
Mailing Address - Phone:178-764-9056
Mailing Address - Fax:
Practice Address - Street 1:1146 SAWYER AVE APT 2
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-1130
Practice Address - Country:US
Practice Address - Phone:787-392-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker