Individual
BRANDON S TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
1049 SUMMERS DR, REXBURG, ID 83440-5335
(208) 359-4841
(208) 359-4842
Mailing address
1049 SUMMERS DR, REXBURG, ID 83440-5335
(208) 359-4841
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
60637
ID
363LF0000X
Family Nurse Practitioner
CNP60637
ID
Other
Enumeration date
08/22/2017
Last updated
10/11/2019
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