Individual
TRACEY W BEFAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1630 COMMANCHE AVE, GREEN BAY, WI 54313-5753
(920) 433-6000
(920) 430-4719
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7210
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
474
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1016871
NATIONAL COMMISSION ON CERTIFIED PHYSICIANS ASSISTANTS
—
01
—
474-023
LICENSE
WI
Enumeration date
12/05/2005
Last updated
11/15/2022
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