Healthcare Provider Details

I. General information

NPI: 1245518174
Provider Name (Legal Business Name): TRACY JO ENGER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N PARK ST
NORTHWOOD ND
58267-4103
US

IV. Provider business mailing address

PO BOX 160
NORTHWOOD ND
58267-0160
US

V. Phone/Fax

Practice location:
  • Phone: 701-587-6000
  • Fax: 701-587-6009
Mailing address:
  • Phone: 701-587-6000
  • Fax: 701-587-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR27367
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: