Provider Demographics
NPI:1497296032
Name:LAPHAM, TRACY LYNN (BSN)
Entity Type:Individual
Prefix:MISS
First Name:TRACY
Middle Name:LYNN
Last Name:LAPHAM
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24750 FLATIRON CT
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-8334
Mailing Address - Country:US
Mailing Address - Phone:661-609-6788
Mailing Address - Fax:
Practice Address - Street 1:24750 FLATIRON CT
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-8334
Practice Address - Country:US
Practice Address - Phone:661-609-6788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA701122163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse