Provider Demographics
NPI:1093292971
Name:WRIGHT, TRACIE LYNN (MSN, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:LYNN
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MSN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97524-4405
Mailing Address - Country:US
Mailing Address - Phone:541-301-4907
Mailing Address - Fax:
Practice Address - Street 1:572 BARTON RD
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-4405
Practice Address - Country:US
Practice Address - Phone:541-301-4907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201802207NP-PP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health