# TRACEY ELIZABETH WILEY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1194785162
- **Gender:** F
- **Credential:** CRNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | TP005855B | PA | Yes |

## Other

- **Enumeration date:** 03/24/2006
- **Last updated:** 04/29/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1007307260034 | MEDICAID GROUP \# | PA |
| 05 | — | 102556669 | — | PA |
| 05 | — | 102556669 0001 | — | PA |
| 01 | — | 25-1716306 | INTERGROUP | PA |
| 01 | — | 867633 | MEDICARE GROUP \# | PA |
| 01 | — | TP005855B | LICENSE | PA |