Healthcare Provider Details

I. General information

NPI: 1316780976
Provider Name (Legal Business Name): TRACY NORMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6926 NE FOURTH PLAIN BLVD
VANCOUVER WA
98661-7254
US

IV. Provider business mailing address

505 SE 184TH AVE UNIT 551
VANCOUVER WA
98683-1943
US

V. Phone/Fax

Practice location:
  • Phone: 360-993-3000
  • Fax: 360-993-3099
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number61576251
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: