Provider Demographics
NPI:1346499738
Name:NELSON, TRACY LYNN (APNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:NELSON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:L
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2923 W LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2626
Mailing Address - Country:US
Mailing Address - Phone:414-328-8050
Mailing Address - Fax:414-328-8054
Practice Address - Street 1:2923 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221-2626
Practice Address - Country:US
Practice Address - Phone:414-328-8050
Practice Address - Fax:414-328-8054
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3486-33363LF0000X
WI116517-30163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3486-033OtherWISCONSIN ADVANCED PRACTICE NURSE PRESCRIBER LICENSE
WI116517OtherSTATE OF WISCONSIN RN LICENSE NUMBER
WI36095200Medicaid
WI684800482Medicare Oscar/Certification