Individual
MRS. TRACEE SHANAE RAIFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
3302 15TH ST, TUSCALOOSA, AL 35401-2732
(205) 558-0877
(659) 219-7033
Mailing address
PO BOX 746063, ATLANTA, GA 30374-6063
(312) 733-9730
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2012042578
MO
363LA2200X
Adult Health Nurse Practitioner
Primary
3-001798
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420041755
—
MO
Enumeration date
12/31/2012
Last updated
07/31/2024
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