Basic Information
| Provider Information | |||||||||
| NPI: | 1538115514 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRACY NIMMERRICHTER-BURGESS | ||||||||
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| OtherOrganizationName: | OAK HARBOR INTERNAL MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 830 SE IRELAND ST | ||||||||
| Address2: | |||||||||
| City: | OAK HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982775502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606757678 | ||||||||
| FaxNumber: | 3602790614 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 SE IRELAND ST | ||||||||
| Address2: | |||||||||
| City: | OAK HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982775502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606757678 | ||||||||
| FaxNumber: | 3602790614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 09/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | NIMMERRICHTER-BURGES | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3606757678 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD00031197 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.