Individual
TRACEY ELIZABETH WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
12 ST PAUL DR STE 210, CHAMBERSBURG, PA 17201-1035
(717) 217-6820
(717) 217-6942
Mailing address
785 5TH AVENUE, SUITE 3, CHAMBERSBURG, PA 17201-4232
(717) 263-9555
(717) 217-4217
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
TP005855B
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007307260034
MEDICAID GROUP #
PA
05
—
102556669
—
PA
05
—
102556669 0001
—
PA
01
—
25-1716306
MULTIPLAN/PHCS
PA
01
—
867633
MEDICARE GROUP #
PA
01
—
TP005855B
LICENSE
PA
Enumeration date
03/24/2006
Last updated
04/29/2020
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