Provider Demographics
NPI:1376921239
Name:OLIVER, TRACEY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 E COUNTRY FIELD CIR
Mailing Address - Street 2:SUITE D
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6659
Mailing Address - Country:US
Mailing Address - Phone:907-357-6121
Mailing Address - Fax:
Practice Address - Street 1:3750 E COUNTRY FIELD CIR
Practice Address - Street 2:SUITE D
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6659
Practice Address - Country:US
Practice Address - Phone:907-357-6121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1539363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology