MEDICARE: MRS. TRACY DAWN SANCHEZ FNP-BC

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	49417	WY
2	363LF0000X	Family Nurse Practitioner	APN.0993714-NP	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APN.0993714-NP	OTHER	CO	APN LICENSE
2	CS04779	OTHER	WY	WYOMING CONTROLLED SUBSTANCE NUMBER
3	49417	OTHER	WY	APN LICENSE
4	RXN.0103185-NP	OTHER	CO	PRESCRIPTIVE AUTHORITY

General Provider Information

NPI Number	:	1710475363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACY DAWN SANCHEZ FNP-BC

Provider Business Mailing Address
First Line	:	319 S WILSON ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2943
Country	:	US
Telephone Number	:	307-577-4832
Fax Number	:	307-577-4841

Provider Business Practice Location Address
First Line	:	319 S WILSON ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2943
Country	:	US
Telephone Number	:	307-577-4832
Fax Number	:	307-577-4841

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

Provider Enumeration Date	:	04/30/2018
Last Update Date	:	05/16/2024

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