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General NPI Number Information
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NPI Number | 1417746330
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Entity Type | Individual
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Provider Name | TRACY ANN ALVAREZ
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Gender | Female
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 2040 YALE AVE
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City | BURLEY
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State | ID
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Zip | 83318-2249
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Country | US
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Telephone | 208-219-9932
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Fax |
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Provider Business Mailing Address
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Address Line | 2040 YALE AVE
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City | BURLEY
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State | ID
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Zip | 83318-2249
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Country | US
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Telephone | 208-219-9932
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | 006413356
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 342000000X
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Taxonomy Name | Transportation Network Company
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License Number | 006413356
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number | 006413356
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number | 006413356
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License Number State | ID
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Taxonomy #5
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 006413356
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License Number State | ID
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