MEDICARE: TRACY CANDACE W. DEGENSTEIN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP30004407	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003895533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY CANDACE W. DEGENSTEIN ARNP

Provider Business Mailing Address
First Line	:	217 TORBETT ST STE 101
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99354-2667
Country	:	US
Telephone Number	:	509-427-1450
Fax Number	:	509-427-1490

Provider Business Practice Location Address
First Line	:	217 TORBETT ST STE 101
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99354-2667
Country	:	US
Telephone Number	:	509-427-1450
Fax Number	:	509-427-1490

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	05/23/2024

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