Provider Demographics
NPI:1194565952
Name:EVERS-SELLECK, TRACY ANN (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ANN
Last Name:EVERS-SELLECK
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3083 NE 49TH PL
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6006
Mailing Address - Country:US
Mailing Address - Phone:503-844-1468
Mailing Address - Fax:
Practice Address - Street 1:3083 NE 49TH PL
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6006
Practice Address - Country:US
Practice Address - Phone:503-844-1468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR094000381163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse