Basic Information
| Provider Information | |||||||||
| NPI: | 1396741609 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRACY | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | NP,CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1685 HOLLAND DRIVE | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252549000 | ||||||||
| FaxNumber: | 9252540687 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 CAMINO ENCINAS | ||||||||
| Address2: | #15 | ||||||||
| City: | ORINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252549000 | ||||||||
| FaxNumber: | 9252540678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | NMW157 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.