Provider Demographics
NPI:1073543484
Name:BROWER, TRACY (CNP)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:BROWER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HWY 1
Mailing Address - Street 2:
Mailing Address - City:RED LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56671-0249
Mailing Address - Country:US
Mailing Address - Phone:218-679-3912
Mailing Address - Fax:218-679-0135
Practice Address - Street 1:HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:RED LAKE
Practice Address - State:MN
Practice Address - Zip Code:56671-0249
Practice Address - Country:US
Practice Address - Phone:218-679-3912
Practice Address - Fax:218-679-0135
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120211-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN240206Medicare Oscar/Certification
MN8HZ54QMedicare PIN
MNP43649Medicare UPIN