Provider Demographics
NPI:1316016728
Name:WAYCASTER, TRACEY MARIE
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:MARIE
Last Name:WAYCASTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 557 BOX 1737
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96379
Mailing Address - Country:JP
Mailing Address - Phone:0118198-737-1881
Mailing Address - Fax:
Practice Address - Street 1:USNH LESTER
Practice Address - Street 2:PSC 482
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96362
Practice Address - Country:JP
Practice Address - Phone:0118198-737-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman