1841369899 NPI number — TRACI LYNN PRAYNER CRNA

Table of content: TRACI LYNN PRAYNER CRNA (NPI 1841369899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841369899 NPI number — TRACI LYNN PRAYNER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRAYNER
Provider First Name:
TRACI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841369899
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1506
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEHALIS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98532-0409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-242-3008
Provider Business Mailing Address Fax Number:
608-077-6873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 1506
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEHALIS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98532-0409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-242-3010
Provider Business Practice Location Address Fax Number:
360-740-1987
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  AP60134098 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , with the licence number: 55608 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: TEMPORARY , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WC0200X , with the licence number: 0001171560 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 145946 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 500839464 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1841369899 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200440240A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0292062 . This is a "LABOR AND INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1841369899 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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