Provider Demographics
NPI:1598127623
Name:TRACY, NERA G (RN)
Entity Type:Individual
Prefix:
First Name:NERA
Middle Name:G
Last Name:TRACY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JUNEAU COUNTY DEPT OF HUMAN SERVICES
Mailing Address - Street 2:200 HICKORY ST
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948
Mailing Address - Country:US
Mailing Address - Phone:608-847-2400
Mailing Address - Fax:608-847-9599
Practice Address - Street 1:JUNEAU COUNTY DEPT OF HUMAN SERVICES
Practice Address - Street 2:200 HICKORY ST
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948
Practice Address - Country:US
Practice Address - Phone:608-847-2400
Practice Address - Fax:608-847-9599
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI198678-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse