Healthcare Provider Details

I. General information

NPI: 1598757643
Provider Name (Legal Business Name): TRACI A FLANIGAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 WESTOWN PKWY SUITE 210
WEST DES MOINES IA
50266-8218
US

IV. Provider business mailing address

5901 WESTOWN PKWY SUITE 210
WEST DES MOINES IA
50266-8218
US

V. Phone/Fax

Practice location:
  • Phone: 515-221-9222
  • Fax: 515-221-0575
Mailing address:
  • Phone: 515-221-9222
  • Fax: 515-221-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberD-082430
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD082430
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: