Provider Demographics
NPI:1417746330
Name:ALVAREZ, TRACY ANN
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:ALVAREZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-2249
Mailing Address - Country:US
Mailing Address - Phone:208-219-9932
Mailing Address - Fax:
Practice Address - Street 1:2040 YALE AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2249
Practice Address - Country:US
Practice Address - Phone:208-219-9932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID006413356347C00000X, 342000000X, 347E00000X, 372500000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate Vehicle
No342000000XTransportation ServicesTransportation Network Company
No347E00000XTransportation ServicesTransportation Broker
No372500000XNursing Service Related ProvidersChore Provider