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General NPI Number Information
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NPI Number | 1215707005
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Entity Type | Individual
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Provider Name | TRACEE CHOUINARD CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 01/03/2024
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 5606 SW LEE BLVD STE 201
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City | LAWTON
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State | OK
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Zip | 73505-9651
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Country | US
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Telephone | 580-699-5333
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Fax |
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Provider Business Mailing Address
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Address Line | 256937 E 1790 RD
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City | GERONIMO
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State | OK
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Zip | 73543-5228
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Country | US
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Telephone | 602-999-9813
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 207449
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License Number State | OK
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