Basic Information
| Provider Information | |||||||||
| NPI: | 1679119101 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITMIRE | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1475 MOUNT HOOD AVE | ||||||||
| Address2: | |||||||||
| City: | WOODBURN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970719066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9719835260 | ||||||||
| FaxNumber: | 9719835326 | ||||||||
| Practice Location | |||||||||
| Address1: | 347 FAIRVIEW ST | ||||||||
| Address2: | |||||||||
| City: | SILVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973811916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038735667 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2019 | ||||||||
| LastUpdateDate: | 12/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 201910257NP-PP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.