Tracee Jon Dahlke, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

202202434NP-PP Issued in OR

Practice address

320 SW 2ND St
Corvallis, OR 97333-4632

Phone

(541) 207-3709

NPI assigned

Mar 20, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Tracee Jon Scott Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1584662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647388800000",
    "number": "1962038018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32949 WILDROSE DR",
            "city": "TANGENT",
            "state": "OR",
            "postal_code": "973899518",
            "telephone_number": "808-265-5970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 SW 2ND ST",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973334632",
            "telephone_number": "541-207-3709"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8855 SW Holly Ln Ste 100",
            "address_purpose": "LOCATION",
            "city": "Wilsonville",
            "state": "OR",
            "postal_code": "970708792",
            "country_code": "US",
            "telephone_number": "808-265-5970",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAHLKE",
        "first_name": "TRACEE",
        "middle_name": "JON",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-20",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LS0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, School",
            "state": "OR",
            "license": "201509445RN",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "202202434NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACEE",
            "last_name": "SCOTT",
            "middle_name": "JON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Angela Joy Dahlke
• Heather Dahlstrom
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• Cassandra Erin Dailey
• Roger Gerald Dailey
• Farrah Dalal, LMFT

• Family Nurse Practitioner in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; 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.