1396334959 NPI number — MRS. TRACIE JAINE DUNCAN

Table of content: MRS. TRACIE JAINE DUNCAN (NPI 1396334959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396334959 NPI number — MRS. TRACIE JAINE DUNCAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNCAN
Provider First Name:
TRACIE
Provider Middle Name:
JAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHERER
Provider Other First Name:
TRACIE
Provider Other Middle Name:
JAINE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396334959
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30101 HOOVER RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-558-6868
Provider Business Mailing Address Fax Number:
586-558-6893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PATHWAYS 2 PLLC 30101 HOOVER RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-558-6868
Provider Business Practice Location Address Fax Number:
586-558-6893
Provider Enumeration Date:
01/18/2021

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: 101YM0800X , with the licence number:  6451022583 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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