Provider Demographics
NPI:1396847869
Name:KREBS, TRACI LEIGH (ARNP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LEIGH
Last Name:KREBS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 CRAIG ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3302
Mailing Address - Country:US
Mailing Address - Phone:509-526-1510
Mailing Address - Fax:
Practice Address - Street 1:3626 NE 45TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5652
Practice Address - Country:US
Practice Address - Phone:206-526-2600
Practice Address - Fax:206-526-0219
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004305363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care