Provider Demographics
NPI:1326043225
Name:SEEL, TRACY ANN (PA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:SEEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3180
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82902-3180
Mailing Address - Country:US
Mailing Address - Phone:307-362-0083
Mailing Address - Fax:307-362-0084
Practice Address - Street 1:1180 COLLEGE DR STE 3-2
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5863
Practice Address - Country:US
Practice Address - Phone:307-362-0083
Practice Address - Fax:307-362-0084
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA54836363AM0700X
WY252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY308604OtherBCBS
WY970018032Medicare PIN
WYW308604Medicare PIN
WYP17281Medicare UPIN