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General NPI Number Information
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NPI Number | 1750819801
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Entity Type | Individual
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Provider Name | TRACY MAUE
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Gender | Female
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Dates
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Enumeration Date | 06/01/2017
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 3333 DEPOSIT DR NE STE 240
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-1470
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Country | US
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Telephone | 616-942-7400
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Fax | 616-942-7405
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Provider Business Mailing Address
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Address Line | PO BOX 40412
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City | BELFAST
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State | ME
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Zip | 04915-1255
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Country | US
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Telephone | 616-942-7400
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Fax | 616-942-7405
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704225720
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704225720
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License Number State | MI
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