MEDICARE: MRS. TRACY JOANNE TEW LPN

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	207Q00000X	Family Medicine Physician	14384	ID

General Provider Information

NPI Number	:	1356273452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACY JOANNE TEW LPN

Provider Business Mailing Address
First Line	:	1529 BELMONT ST.
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706
Country	:	US
Telephone Number	:	208-426-6248
Fax Number	:

Provider Business Practice Location Address
First Line	:	1529 BELMONT STREET
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706
Country	:	US
Telephone Number	:	208-426-1459
Fax Number	:	208-426-3005

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

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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