Tracy Wruk
Individual provider Active NPI Licensed Practical Nurse · Crivitz, WI
NPI 1629520143 · NPPES record last updated Nov 1, 2016
Key facts
- NPI
- 1629520143
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 319630-31 (WI)
- Practice address
- N9319 Boat Landing 3 Rd
Crivitz, WI 54114-8173 - Phone
- (715) 927-0096
- NPI assigned
- Nov 1, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 319630-31 | WI | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 319630-31 | WI | Yes |
Addresses
Primary practice location
N9319 Boat Landing 3 Rd
Crivitz, WI 54114-8173
Mailing address
N9319 Boat Landing 3 Rd
Crivitz, WI 54114-8173
Phone (715) 927-0096
Other providers in Crivitz, WI
All providers in Crivitz, WI · Licensed Practical Nurse in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.