MEDICARE: TRACIE KOVAC R.N.

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	163WS0200X	School Registered Nurse	RN00103234	WA

General Provider Information

NPI Number	:	1639539679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACIE KOVAC R.N.

Provider Business Mailing Address
First Line	:	3803 INTERLAKE AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8129
Country	:	US
Telephone Number	:	206-371-5303
Fax Number	:

Provider Business Practice Location Address
First Line	:	3803 INTERLAKE AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8129
Country	:	US
Telephone Number	:	206-371-5303
Fax Number	:

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

Provider Enumeration Date	:	03/03/2016
Last Update Date	:	03/03/2016

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