Healthcare Provider Details

I. General information

NPI: 1831390483
Provider Name (Legal Business Name): MEGAN TRACEY RN, PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 WELCH RD RM 3167 MC 5928
PALO ALTO CA
94304-1601
US

IV. Provider business mailing address

44 SELKIRK ST
OAKLAND CA
94619-1626
US

V. Phone/Fax

Practice location:
  • Phone: 650-721-6737
  • Fax: 650-721-6748
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberNP12936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: