Provider Demographics
NPI:1447385000
Name:EBERT, TRACI LYNN (CRNA)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNN
Last Name:EBERT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:LYNN
Other - Last Name:LORENZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 281
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:NE
Mailing Address - Zip Code:68979-0281
Mailing Address - Country:US
Mailing Address - Phone:402-440-3548
Mailing Address - Fax:
Practice Address - Street 1:3610 RICHMOND CIRCLE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803
Practice Address - Country:US
Practice Address - Phone:308-384-6400
Practice Address - Fax:308-398-6420
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100975367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered