Basic Information
| Provider Information | |||||||||
| NPI: | 1609357813 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LE | ||||||||
| FirstName: | TRACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 16TH AVENUE EAST | ||||||||
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| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063263000 | ||||||||
| FaxNumber: | 2063264845 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 SW 146TH ST | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981661912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2066303000 | ||||||||
| FaxNumber: | 2066303001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2018 | ||||||||
| LastUpdateDate: | 03/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | AP60882882 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.