Provider Demographics
NPI:1043691538
Name:PERG, TRACI GISELLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:GISELLE
Last Name:PERG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:TRACI
Other - Middle Name:GISELLE
Other - Last Name:LYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2111 CHAMPA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2529
Mailing Address - Country:US
Mailing Address - Phone:303-293-2217
Mailing Address - Fax:
Practice Address - Street 1:2100 N BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2526
Practice Address - Country:US
Practice Address - Phone:303-293-2217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1632589163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health