Healthcare Provider Details

I. General information

NPI: 1982074159
Provider Name (Legal Business Name): TRACEY SCHAPER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 MISSION GROVE PKWY N
RIVERSIDE CA
92506-6246
US

IV. Provider business mailing address

297 MISSION GROVE PKWY N
RIVERSIDE CA
92506-6246
US

V. Phone/Fax

Practice location:
  • Phone: 949-933-8133
  • Fax:
Mailing address:
  • Phone: 949-933-8133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number95001561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: