Provider Demographics
NPI:1831698158
Name:CLOUSER, TRACY NICOLE (CRNP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:NICOLE
Last Name:CLOUSER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:NICOLE
Other - Last Name:DONATELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:248 ZIEGLER RD
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-9413
Mailing Address - Country:US
Mailing Address - Phone:610-780-0903
Mailing Address - Fax:
Practice Address - Street 1:2607 KEISER BLVD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3338
Practice Address - Country:US
Practice Address - Phone:610-743-3139
Practice Address - Fax:610-743-3143
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily