Individual
TRACEY D. MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
214 E 23RD ST, CHEYENNE REGIONAL MEDICAL CENTER, EMERGENCY DEPT., CHEYENNE, WY 82001-3748
(307) 634-2273
(307) 633-7671
Mailing address
1241 W MINERAL AVE, SUITE 100, LITTLETON, CO 80120-5685
(303) 759-0854
(303) 759-0864
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
175880851
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123828100
—
WY
01
—
314502
BCBS
WY
05
—
35177837
—
CO
Enumeration date
09/25/2006
Last updated
05/11/2009
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