MEDICARE: TRACY WINGERT

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	5838118-4405	UT

General Provider Information

NPI Number	:	1447244652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY WINGERT

Provider Business Mailing Address
First Line	:	6040 SHARON CIR
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-5006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7321 11TH ST
Second Line	:
City	:	HILL AFB
State	:	UT
Zip	:	84056-5012
Country	:	US
Telephone Number	:	801-586-9703
Fax Number	:

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	07/08/2007

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