Basic Information
| Provider Information | |||||||||
| NPI: | 1043534142 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMOS | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1815 E 19TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | THE DALLES | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970583385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413166575 | ||||||||
| FaxNumber: | 5412108913 | ||||||||
| Practice Location | |||||||||
| Address1: | 176 1ST AVE N | ||||||||
| Address2: | |||||||||
| City: | ILWACO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606423747 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2010 | ||||||||
| LastUpdateDate: | 02/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246Z00000X | AT-AT-10148406 | OR | N | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | 363A00000X | PA207993 | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | PA60866658 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.