Provider Demographics
NPI:1003895533
Name:DEGENSTEIN, TRACY CANDACE W (ARNP)
Entity type:Individual
Prefix:
First Name:TRACY CANDACE
Middle Name:W
Last Name:DEGENSTEIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 TORBETT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2667
Mailing Address - Country:US
Mailing Address - Phone:509-427-1450
Mailing Address - Fax:509-427-1490
Practice Address - Street 1:217 TORBETT ST STE 101
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2667
Practice Address - Country:US
Practice Address - Phone:509-427-1450
Practice Address - Fax:509-427-1490
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004407363LF0000X, 363LW0102X
WI3761363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2058433Medicaid
WA546348Medicare UPIN
WA9621251Medicaid