Healthcare Provider Details

I. General information

NPI: 1871419440
Provider Name (Legal Business Name): TRACY L UNDERWOOD MSN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 36TH AVE
MOLINE IL
61265-7127
US

IV. Provider business mailing address

409 PIN OAK DR
GENESEO IL
61254-1952
US

V. Phone/Fax

Practice location:
  • Phone: 309-743-6700
  • Fax:
Mailing address:
  • Phone: 309-631-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA192004
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: