Provider Demographics
NPI:1780677161
Name:DICKEL, TRACY ANN (ARNP FNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:DICKEL
Suffix:
Gender:F
Credentials:ARNP FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 HICKMAN RD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-1505
Mailing Address - Country:US
Mailing Address - Phone:515-282-2200
Mailing Address - Fax:515-282-2231
Practice Address - Street 1:1801 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1505
Practice Address - Country:US
Practice Address - Phone:515-282-2200
Practice Address - Fax:515-282-2231
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA062100163W00000X
IAA062100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0219733Medicaid
IAP00112921OtherRAILROAD MEDICARE
IA48413OtherWELLMARK BCBS
IAB003OtherTRIWEST
IA1219733Medicaid
IA42068106098OtherJOHN DEERE HEALTH
IAUNKOtherIOWA HEALTH SOLUTIONS
IAP00112921OtherRAILROAD MEDICARE
IAUNKOtherIOWA HEALTH SOLUTIONS
IAB003OtherTRIWEST