MEDICARE: TRACY COLE RATZLAFF CRNA

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	367500000X	Certified Registered Nurse Anesthetist	R44655	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285736314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY COLE RATZLAFF CRNA

Provider Business Mailing Address
First Line	:	1101 DOUGLAS AVENUE
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3932
Country	:	US
Telephone Number	:	505-434-7289
Fax Number	:	505-434-7299

Provider Business Practice Location Address
First Line	:	1101 DOUGLAS AVENUE
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3932
Country	:	US
Telephone Number	:	505-434-7289
Fax Number	:	505-434-7299

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	02/09/2022

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