Provider Demographics
NPI:1609357813
Name:LE, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 16TH AVENUE EAST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112
Mailing Address - Country:US
Mailing Address - Phone:206-326-3000
Mailing Address - Fax:206-326-4845
Practice Address - Street 1:140 SW 146TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1912
Practice Address - Country:US
Practice Address - Phone:206-630-3000
Practice Address - Fax:206-630-3001
Is Sole Proprietor?:No
Enumeration Date:2018-08-25
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60882882363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health