Healthcare Provider Details

I. General information

NPI: 1760734560
Provider Name (Legal Business Name): TRACY ANN WURM D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY ANN SHEBAH D.O.

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 11/14/2020
Certification Date: 11/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9120 W POST RD STE 200
LAS VEGAS NV
89148-2427
US

IV. Provider business mailing address

8906 SPANISH RIDGE AVE STE 202
LAS VEGAS NV
89148-1319
US

V. Phone/Fax

Practice location:
  • Phone: 702-870-2229
  • Fax: 702-870-0515
Mailing address:
  • Phone: 702-330-3102
  • Fax: 702-912-4994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1984
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: