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Individual
TRACY ANNETTE VAN WIEREN
Active
Individual
TRACY ANNETTE VAN WIEREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP - C
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
589263
TX
363L00000X
Nurse Practitioner
Primary
AP117651
TX
363LA2200X
Adult Health Nurse Practitioner
AP117651
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200984701
—
TX
01
—
200984702
MEDICAID-CSHCN
TX
01
—
8Y9639
BCBS
TX
Enumeration date
03/06/2009
Last updated
03/03/2023
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