Provider Demographics
NPI:1427048651
Name:MCDANIEL, TRACY S (ND,LM)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:S
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:ND,LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6327 22ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6919
Mailing Address - Country:US
Mailing Address - Phone:206-363-5555
Mailing Address - Fax:206-363-5533
Practice Address - Street 1:6327 22ND AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6919
Practice Address - Country:US
Practice Address - Phone:206-363-5555
Practice Address - Fax:206-363-5533
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT1136175F00000X
WAMW00000275176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3567MCOtherREGENCE
WA8352494Medicaid
WA6356MCOtherREGENCE MIDWIFERY