Individual
MRS. TRACY LEE BAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1424 BROADWAY, EVERETT, WA 98201-1720
(425) 789-2000
Mailing address
1428 WARM SPRINGS DR, DUBOIS, WY 82513-9760
(307) 455-2807
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP61479503
WA
363L00000X
Nurse Practitioner
CP000450
SD
363LF0000X
Family Nurse Practitioner
33105.1295
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136115500
—
WY
01
—
4994284
BCBS OF SD
SD
Enumeration date
06/20/2006
Last updated
10/02/2023
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