Provider Demographics
NPI:1629859558
Name:BJUGSTAD, TRACY LYNN (RN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:BJUGSTAD
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 1:411 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-3932
Mailing Address - Country:US
Mailing Address - Phone:701-210-1446
Mailing Address - Fax:
Practice Address - Street 1:411 4TH ST N
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-3932
Practice Address - Country:US
Practice Address - Phone:701-210-1446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR55205163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse