Individual
TRACI LYNN PANTZKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2301 25TH ST S, STE K, FARGO, ND 58103-6104
(701) 234-1728
(701) 234-1628
Mailing address
2301 25TH ST S, STE K, FARGO, ND 58103-6104
(701) 234-1728
(701) 234-1628
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R22825
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020823
ND BLUE SHIELD
ND
05
—
10221
—
ND
01
—
131R8PA
MN BLUE SHIELD
MN
Enumeration date
05/10/2006
Last updated
11/15/2007
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