Provider Demographics
NPI:1811278989
Name:DEARING-JUDE, TRACEY LEE (CNP)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:LEE
Last Name:DEARING-JUDE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:LEE
Other - Last Name:DEARING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:MR 10809
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-0043
Mailing Address - Country:US
Mailing Address - Phone:612-262-4813
Mailing Address - Fax:612-262-4194
Practice Address - Street 1:2925 CHICAGO AVE
Practice Address - Street 2:VPCI, BUFFALO ALLINA HEALTH
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1321
Practice Address - Country:US
Practice Address - Phone:612-262-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1333363L00000X
MNR147500-3363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily