Provider Demographics
NPI:1841369899
Name:PRAYNER, TRACI LYNN (CRNA)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:LYNN
Last Name:PRAYNER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:608-077-6873
Practice Address - Street 1:PO BOX 1506
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-0409
Practice Address - Country:US
Practice Address - Phone:360-242-3010
Practice Address - Fax:360-740-1987
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60134098367500000X
KS55608367500000X
CATEMPORARY367500000X
VA0001171560163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS145946OtherBCBS
OR500839464Medicaid
ID1841369899Medicaid
KS200440240AMedicaid
WA0292062OtherLABOR AND INDUSTRY
WA1841369899Medicaid