Provider Demographics
NPI:1154395929
Name:FICHTER, TRACI L (APRN)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:L
Last Name:FICHTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 INDIAN HILLS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4057
Mailing Address - Country:US
Mailing Address - Phone:402-397-7057
Mailing Address - Fax:402-397-6656
Practice Address - Street 1:8901 INDIAN HILLS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4057
Practice Address - Country:US
Practice Address - Phone:402-397-7057
Practice Address - Fax:402-397-6656
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SDCP000416363LF0000X
NE110996363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47077295213Medicaid
SDHP43026OtherHEALTHPARTNERS
MN323M4BROtherCC SYSTEMS/ BLUE PLUS
IA1913624Medicaid
NE46022474338Medicaid
NE47077295213Medicaid
IA1913624Medicaid