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Individual

TRACEY JOANNE FENDER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.N.P.

Contact information

Practice address
167 NORTH MAIN ST., TUBA CITY, AZ 86045
(928) 283-2679
Mailing address
167 NORTH MAIN ST., TUBA CITY, AZ 86045
(928) 283-2679

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
064991-23
NH
363LP0200X
Pediatric Nurse Practitioner
Primary
AP2858
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
064991-23
STATE
NH
01
AP2858
AZ STATE BOARD OF NURSING
AZ
01
RN2271333
STATE
MA
Enumeration date
09/18/2007
Last updated
05/16/2013
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