Individual
TRACY FOWLER FUQUAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(919) 784-3034
Mailing address
PO BOX 18139, RALEIGH, NC 27619-8139
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
145609
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8052595
—
NC
01
—
P00662400
RAILROAD-MEDICARE
NC
Enumeration date
10/04/2006
Last updated
02/23/2009
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