Healthcare Provider Details

I. General information

NPI: 1467781021
Provider Name (Legal Business Name): TRACEY L WIESE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8143 HARVEST CIR
ANCHORAGE AK
99502-4682
US

IV. Provider business mailing address

8143 HARVEST CIR
ANCHORAGE AK
99502-4682
US

V. Phone/Fax

Practice location:
  • Phone: 907-793-0686
  • Fax: 726-232-5849
Mailing address:
  • Phone: 907-793-0686
  • Fax: 726-232-5849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1121
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1121
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: