Provider Demographics
NPI:1851644116
Name:NOURSE, TRACY D (RN)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:D
Last Name:NOURSE
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 1:610 N MONTANA ST # CL7
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-3353
Mailing Address - Country:US
Mailing Address - Phone:406-683-5570
Mailing Address - Fax:406-683-6489
Practice Address - Street 1:610 N MONTANA ST # CL7
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3353
Practice Address - Country:US
Practice Address - Phone:406-683-5570
Practice Address - Fax:406-683-6489
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT44790163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse