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NPI Code Detail

MEDICARE: MRS. TRACIE LINE DETWILER NNP

MEDICARE: MRS. TRACIE LINE DETWILER NNP
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
1363LN0000XNeonatal Nurse Practitioner83095CO

General Provider Information

NPI Number : 1619981347
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRACIE LINE DETWILER NNP
Provider Business Mailing Address
First Line : 1024 CENTRAL PARK DR
Second Line :
City : STEAMBOAT SPRINGS
State : CO
Zip : 80487-8813
Country : US
Telephone Number : 970-871-2418
Fax Number : 970-871-2480
Provider Business Practice Location Address
First Line : 1024 CENTRAL PARK DR
Second Line :
City : STEAMBOAT SPRINGS
State : CO
Zip : 80487-8813
Country : US
Telephone Number : 970-871-2418
Fax Number : 970-871-2480
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2006
Last Update Date : 07/11/2013

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