Healthcare Provider Details

I. General information

NPI: 1255409546
Provider Name (Legal Business Name): TRACY A RENN FNP-BC, ACNS-BC APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 TIERNEY DR
NEW RICHMOND WI
54017-2515
US

IV. Provider business mailing address

893 WILLOW RIVER DR
HUDSON WI
54016-6944
US

V. Phone/Fax

Practice location:
  • Phone: 715-246-2521
  • Fax: 715-246-7977
Mailing address:
  • Phone: 715-246-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number2006008321-05
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2077005215-22
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: