Provider Demographics
NPI:1669701744
Name:MOE, TRACI ANN (APNP)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:ANN
Last Name:MOE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MRS
Other - First Name:TRACI
Other - Middle Name:ANN
Other - Last Name:LINDVIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APNP
Mailing Address - Street 1:1836 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5429
Mailing Address - Country:US
Mailing Address - Phone:608-782-7300
Mailing Address - Fax:
Practice Address - Street 1:1836 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-5429
Practice Address - Country:US
Practice Address - Phone:608-782-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3938363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health