Individual
TRACIE BARETELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
HC 63 BOX 9000, DILKON, AZ 86047-9477
(928) 657-1000
(928) 289-6229
Mailing address
5349 W CANARY GRASS WAY, SOUTH JORDAN, UT 84009-1399
(360) 689-6397
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
PA10005007
WA
363A00000X
Physician Assistant
Primary
9887
AZ
363A00000X
Physician Assistant
PA10005007
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8451411
—
WA
Enumeration date
03/21/2006
Last updated
11/24/2024
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