Provider Demographics
NPI:1568812568
Name:MATINCHECK, TRACEE L (CRNP)
Entity Type:Individual
Prefix:
First Name:TRACEE
Middle Name:L
Last Name:MATINCHECK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TRACEE
Other - Middle Name:L
Other - Last Name:WILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1025 W HARRISBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-4848
Mailing Address - Country:US
Mailing Address - Phone:717-944-0491
Mailing Address - Fax:717-944-1436
Practice Address - Street 1:1025 W HARRISBURG PIKE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-4848
Practice Address - Country:US
Practice Address - Phone:717-944-0491
Practice Address - Fax:717-944-1436
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016306363L00000X
PARN538307363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103118722Medicaid
PA103118722Medicaid