Individual
TRACY ANN THREAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
5555 CONNER ST, SUITE 2691, DETROIT, MI 48213-3448
(313) 579-1182
(313) 579-5128
Mailing address
5555 CONNER ST STE 2691, DETROIT, MI 48213-3812
(313) 692-8400
(313) 692-8427
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704223743
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11971276
CAQH ID
MI
Enumeration date
07/30/2008
Last updated
11/18/2021
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