1417026550 NPI number — TRACY L BEECHER APRN, FNP-C

Table of content: TRACY L BEECHER APRN, FNP-C (NPI 1417026550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417026550 NPI number — TRACY L BEECHER APRN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEECHER
Provider First Name:
TRACY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-C
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:
1417026550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4674 40TH AVE S STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58104-4501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-552-5855
Provider Business Mailing Address Fax Number:
866-728-8316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4674 40TH AVE S STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58104-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-552-5855
Provider Business Practice Location Address Fax Number:
866-728-8316
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: 363L00000X , with the licence number:  R28756 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 19850 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1417026550 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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