Provider Demographics
NPI:1073196119
Name:TRACY HAWSE NP LLC
Entity Type:Organization
Organization Name:TRACY HAWSE NP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWSE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:530-613-1284
Mailing Address - Street 1:150 S AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-6576
Mailing Address - Country:US
Mailing Address - Phone:530-613-1284
Mailing Address - Fax:866-247-1585
Practice Address - Street 1:150 S AUBURN ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-6576
Practice Address - Country:US
Practice Address - Phone:530-613-1284
Practice Address - Fax:866-247-1585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care