Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP30004407 | WA |
NPI | 1003895533 |
---|---|
Provider Name | Tracy Candace W. Degenstein |
First Address | Richland, WA 99354-2604 |
Second Address | Richland--, WA 99354-1185 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 01/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2058433 | (05) | WA |
546348 | (02) | WA |