Provider Demographics
NPI:1942238753
Name:HIEGEL, TRACI LYNN (MD)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNN
Last Name:HIEGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:LYNN
Other - Last Name:VALADEZ-HIEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6520 226TH PL SE
Mailing Address - Street 2:STE 100
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8969
Mailing Address - Country:US
Mailing Address - Phone:425-369-0808
Mailing Address - Fax:425-369-0770
Practice Address - Street 1:6520 226TH PL SE
Practice Address - Street 2:STE 100
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8969
Practice Address - Country:US
Practice Address - Phone:425-369-0808
Practice Address - Fax:425-369-0770
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037522208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G92521Medicare UPIN
GAB32126Medicare ID - Type Unspecified