1760443444 NPI number — DR. TRACI LEE DRAKE PHD

Table of content: DR. TRACI LEE DRAKE PHD (NPI 1760443444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760443444 NPI number — DR. TRACI LEE DRAKE PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRAKE
Provider First Name:
TRACI
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEE
Provider Other First Name:
TRACI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760443444
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9601 STEILACOOM BLVD SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98498-7212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-756-2991
Provider Business Mailing Address Fax Number:
253-756-2879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9601 STEILACOOM BLVD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98498-7212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-756-2991
Provider Business Practice Location Address Fax Number:
253-756-2879
Provider Enumeration Date:
03/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PY00003290 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)