Individual
AMBER TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
555 BLACK OAK DR, MEDFORD, OR 97504-8447
(541) 789-2273
Mailing address
555 BLACK OAK DR, MEDFORD, OR 97504-8447
(541) 789-2273
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
10030184
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/11/2021
Last updated
07/23/2024
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