Healthcare Provider Details

I. General information

NPI: 1134317639
Provider Name (Legal Business Name): TRACY RANEA KRAUSS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 827 BOX 64
FPO AE
09617
US

IV. Provider business mailing address

PSC 827 BOX 64
FPO AE
09617
US

V. Phone/Fax

Practice location:
  • Phone: 81-811-7349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number194002
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: