Individual
TRACEE RAINEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-BC
Contact information
Practice address
9900 BREN RD E, MAIL ROUTE MN 008-B213, MINNETONKA, MN 55343-9664
(469) 992-6702
Mailing address
918 SOUTHWESTERN DR, CEDAR HILL, TX 75104-5552
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
724171
TX
363LA2200X
Adult Health Nurse Practitioner
Primary
AP122940
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2035487-03
GROUP TPI
TX
01
—
314177YNEA
MEDICARE PTAN
TX
01
—
323183-01
MEDICAID TPI
TX
01
—
3232183-01
IND TPI
TX
01
—
8865NA
BCBS
TX
01
—
D07564
RAILROAD GROUP
TX
01
—
P01237942
RAILROAD PTAN
TX
Enumeration date
12/27/2012
Last updated
09/17/2020
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