Provider Demographics
NPI:1326461435
Name:MCDOUGALL, TRACY (CNM)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:MCDOUGALL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 W BETHANY HOME RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019-1953
Mailing Address - Country:US
Mailing Address - Phone:602-973-3200
Mailing Address - Fax:602-795-3714
Practice Address - Street 1:3660 W BETHANY HOME RD
Practice Address - Street 2:SUITE A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-1953
Practice Address - Country:US
Practice Address - Phone:602-973-3200
Practice Address - Fax:602-795-3714
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5344367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife