Provider Demographics
NPI:1194016527
Name:OJAKANGAS, TRACIE LR (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:LR
Last Name:OJAKANGAS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4661 N FARM ROAD 159
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-8123
Mailing Address - Country:US
Mailing Address - Phone:417-833-6824
Mailing Address - Fax:
Practice Address - Street 1:4661 N FARM ROAD 159
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-8123
Practice Address - Country:US
Practice Address - Phone:417-833-6824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010041402163W00000X
MOF1110060363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse