MEDICARE: MS. CAROL LYNN TRACY NP,CNM

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	367A00000X	Advanced Practice Midwife	NMW157	CA

General Provider Information

NPI Number	:	1396741609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL LYNN TRACY NP,CNM

Provider Business Mailing Address
First Line	:	1685 HOLLAND DRIVE
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597
Country	:	US
Telephone Number	:	925-254-9000
Fax Number	:	925-254-0687

Provider Business Practice Location Address
First Line	:	12 CAMINO ENCINAS
Second Line	:	#15
City	:	ORINDA
State	:	CA
Zip	:	94563
Country	:	US
Telephone Number	:	925-254-9000
Fax Number	:	925-254-0678

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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