Provider Demographics
NPI:1760734560
Name:WURM, TRACY ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:ANN
Last Name:WURM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TRACY
Other - Middle Name:ANN
Other - Last Name:SHEBAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:8906 SPANISH RIDGE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1319
Mailing Address - Country:US
Mailing Address - Phone:702-330-3102
Mailing Address - Fax:702-912-4994
Practice Address - Street 1:9120 W POST RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2427
Practice Address - Country:US
Practice Address - Phone:702-870-2229
Practice Address - Fax:702-870-0515
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1984207V00000X
NJ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1760734560Medicaid
NVV111171Medicare PIN