Individual
TRACI L. FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1700 SW 7TH ST, TOPEKA, KS 66606-2489
(858) 452-9537
Mailing address
1700 SW 7TH ST, TOPEKA, KS 66606-2489
(785) 295-8000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
97354
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
557001
KS
Other
Enumeration date
12/16/2010
Last updated
10/06/2023
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