Individual
MRS. TRACY SHARI WOLLENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
650 HUEBNER RD, FORT RILEY, KS 66442-4030
(785) 240-7652
Mailing address
650 HUEBNER RD, FORT RILEY, KS 66442-4030
(785) 240-7652
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
53-76420
KS
363LW0102X
Women's Health Nurse Practitioner
53-76420
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201120250A
—
KS
Enumeration date
07/09/2014
Last updated
03/23/2018
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