Provider Demographics
NPI:1639389422
Name:WRIGHT, TRACY (RD, LN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:RD, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30161 DODGE DRAW RD
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57442-7802
Mailing Address - Country:US
Mailing Address - Phone:605-765-2111
Mailing Address - Fax:605-765-2117
Practice Address - Street 1:30161 DODGE DRAW RD
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:SD
Practice Address - Zip Code:57442-7802
Practice Address - Country:US
Practice Address - Phone:605-765-2111
Practice Address - Fax:605-765-2117
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0289133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered