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Individual
TRACI MANCUSO
Active
Individual
TRACI MANCUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
289174
AZ
363LF0000X
Family Nurse Practitioner
AP30006855
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02961562
—
NY
05
—
1014638
—
WA
05
—
9644394
—
WA
Enumeration date
09/29/2006
Last updated
04/02/2024
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