MEDICARE: TRACEY J KNIESS CRNP

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	TP004973W	PA

General Provider Information

NPI Number	:	1295734846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY J KNIESS CRNP

Provider Business Mailing Address
First Line	:	128 WILLIAM DR
Second Line	:
City	:	CORAOPOLIS
State	:	PA
Zip	:	15108-3428
Country	:	US
Telephone Number	:	412-809-8934
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 ADAMS SHOPPES
Second Line	:
City	:	MARS
State	:	PA
Zip	:	16046-3966
Country	:	US
Telephone Number	:	724-779-5062
Fax Number	:

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

Provider Enumeration Date	:	07/17/2005
Last Update Date	:	11/21/2008

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