Provider Demographics
NPI:1477013621
Name:MAYER, TRACY (RN, MSN, FNP STUDENT)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MAYER
Suffix:
Gender:F
Credentials:RN, MSN, FNP STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 W 2200 S
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-8511
Mailing Address - Country:US
Mailing Address - Phone:801-726-2047
Mailing Address - Fax:801-387-2400
Practice Address - Street 1:3838 W 2200 S
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-8511
Practice Address - Country:US
Practice Address - Phone:801-726-2047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT190300-3102163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice