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General NPI Number Information
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NPI Number | 1356388094
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Entity Type | Individual
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Provider Name | TRACI M. FRYE R.N., F.N.P.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 12/27/2016
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Provider Practice Location Address
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Address Line | 100 N. EAST STREET
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City | JOSEPH
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State | OR
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Zip | 97846
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Country | US
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Telephone | 541-432-7777
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Fax | 541-432-7170
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Provider Business Mailing Address
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Address Line | 601 MEDICAL PKWY
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City | ENTERPRISE
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State | OR
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Zip | 97828-5124
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Country | US
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Telephone | 541-426-5460
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 093000596N1
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License Number State | OR
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