MEDICARE: TRACY A DONAHUE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	71000396A	IN

General Provider Information

NPI Number	:	1093718173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY A DONAHUE FNP

Provider Business Mailing Address
First Line	:	14540 PRAIRIE LAKES BLVD N
Second Line	:	SUITE 207
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-4366
Country	:	US
Telephone Number	:	317-621-2455
Fax Number	:	317-355-6166

Provider Business Practice Location Address
First Line	:	14540 PRAIRIE LAKES BLVD N
Second Line	:	SUITE 207
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-4366
Country	:	US
Telephone Number	:	317-621-2455
Fax Number	:	317-355-6166

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/01/2013

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