Tracy Lynn Ingham, NP-C

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

A0611105 Issued in MN

Practice address

424 W State Highway 5
Lakeview Clinic LTD
Waconia, MN 55387-1723

Phone

(952) 442-4461

Fax

(952) 442-1213

NPI assigned

Aug 30, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Tracy Lynn Stamboldjiev Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478131200000",
    "number": "1821379272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3603 RAINBOW DR",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553451036",
            "telephone_number": "651-895-9464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 W STATE HIGHWAY 5",
            "address_2": "LAKEVIEW CLINIC LTD",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871723",
            "telephone_number": "952-442-4461",
            "fax_number": "952-442-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INGHAM",
        "first_name": "TRACY",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-30",
        "last_updated": "2016-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "A0611105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "STAMBOLDJIEV",
            "middle_name": "LYNN",
            "credential": "NP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elisabeth Hurliman, MD
• Cerena Ice
• Jennifer C Infanger, MSW
• Infinite Health Collaborative, PA
• Infinite Health Collaborative, PA
• Madison Lynn Isaak, PHARMD
• Christina Beth Ische, CNP
• Jennifer Kristin Ische, D.O.
• Bailey Iverson
• David Scott Jackson, CRNA

• Adult Health Nurse Practitioner in Waconia, MN
• Providers in Waconia, MN by specialty
• Adult Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.