Individual
MRS. TRACY LYTLE HUFFSTATLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN, RN, ACNP-BC
Contact information
Practice address
4914 INNOVATION DR, DEFOREST, WI 53532-2839
(901) 552-7885
Mailing address
4914 INNOVATION DR, DEFOREST, WI 53532-2839
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
13915-33
WI
363LA2100X
Acute Care Nurse Practitioner
13849
TN
363LA2100X
Acute Care Nurse Practitioner
22889
WI
Other
Enumeration date
12/17/2008
Last updated
04/04/2024
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