Provider Demographics
NPI:1952329401
Name:HINAUS, TRACIE ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TRACIE
Middle Name:ANN
Last Name:HINAUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1842
Mailing Address - Country:US
Mailing Address - Phone:715-344-0701
Mailing Address - Fax:
Practice Address - Street 1:500 VINCENT ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1848
Practice Address - Country:US
Practice Address - Phone:715-344-0701
Practice Address - Fax:715-344-4494
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1122023363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42986500Medicaid
WI970016614OtherRAILROAD MEDICARE PROVIDER NUMBER
WI42986500Medicaid
000450105Medicare ID - Type Unspecified
WI0917050001Medicare NSC