1710475363 NPI number — MRS. TRACY DAWN SANCHEZ FNP-BC

Table of content: MRS. TRACY DAWN SANCHEZ FNP-BC (NPI 1710475363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710475363 NPI number — MRS. TRACY DAWN SANCHEZ FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANCHEZ
Provider First Name:
TRACY
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERKINS
Provider Other First Name:
TRACY
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710475363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
319 S WILSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASPER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82601-2943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-577-4832
Provider Business Mailing Address Fax Number:
307-577-4841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 S WILSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASPER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82601-2943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-577-4832
Provider Business Practice Location Address Fax Number:
307-577-4841
Provider Enumeration Date:
04/30/2018

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: 363LF0000X , with the licence number:  49417 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: APN.0993714-NP , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: APN.0993714-NP . This is a "APN LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: CS04779 . This is a "WYOMING CONTROLLED SUBSTANCE NUMBER" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 49417 . This is a "APN LICENSE" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: RXN.0103185-NP . This is a "PRESCRIPTIVE AUTHORITY" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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