Provider Demographics
NPI:1538115514
Name:TRACY NIMMERRICHTER-BURGESS
Entity Type:Organization
Organization Name:TRACY NIMMERRICHTER-BURGESS
Other - Org Name:OAK HARBOR INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIMMERRICHTER-BURGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-675-7678
Mailing Address - Street 1:830 SE IRELAND ST
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5502
Mailing Address - Country:US
Mailing Address - Phone:360-675-7678
Mailing Address - Fax:360-279-0614
Practice Address - Street 1:830 SE IRELAND ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5502
Practice Address - Country:US
Practice Address - Phone:360-675-7678
Practice Address - Fax:360-279-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8859219Medicare ID - Type Unspecified