Provider Demographics
NPI:1386995025
Name:KARDOES, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:KARDOES
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 1:212 COUNTY ROAD 37
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-2192
Mailing Address - Country:US
Mailing Address - Phone:952-758-4461
Mailing Address - Fax:952-758-5011
Practice Address - Street 1:212 COUNTY ROAD 37
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-2192
Practice Address - Country:US
Practice Address - Phone:952-758-4461
Practice Address - Fax:952-758-5011
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN209891-3363LF0000X
MN832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily