Healthcare Provider Details

I. General information

NPI: 1457761546
Provider Name (Legal Business Name): TRACY MERTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E ROSSER AVE STE. 113
BISMARCK ND
58501-4058
US

IV. Provider business mailing address

415 E ROSSER AVE STE. 113
BISMARCK ND
58501-4058
US

V. Phone/Fax

Practice location:
  • Phone: 701-222-6670
  • Fax:
Mailing address:
  • Phone: 701-222-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3060
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: