Provider Demographics
NPI:1629589973
Name:WAY, TRACEY
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:WAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 JAY ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80214-8153
Mailing Address - Country:US
Mailing Address - Phone:303-709-4909
Mailing Address - Fax:
Practice Address - Street 1:1800 WILLIAMS ST
Practice Address - Street 2:300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1234
Practice Address - Country:US
Practice Address - Phone:720-754-2610
Practice Address - Fax:720-754-2659
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993467-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily