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General NPI Number Information
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NPI Number | 1003991209
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Entity Type | Individual
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Provider Name | TRACY LYNN CLASON ARNP
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 108 SE 124TH AVE SUITE 22
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City | VANCOUVER
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State | WA
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Zip | 98684-6015
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Country | US
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Telephone | 360-882-7603
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Fax | 360-896-0337
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Provider Business Mailing Address
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Address Line | 18208 SE 41ST WAY
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City | VANCOUVER
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State | WA
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Zip | 98683-8280
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Country | US
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Telephone | 360-771-6493
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP30007537
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License Number State | WA
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