Provider Demographics
NPI:1699112177
Name:WAKEFIELD, TRACI A (NP)
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:A
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:A
Other - Last Name:WAKEFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:5801 BREMO RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1907
Mailing Address - Country:US
Mailing Address - Phone:804-282-5011
Mailing Address - Fax:804-285-1338
Practice Address - Street 1:5801 BREMO RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:804-282-5011
Practice Address - Fax:804-285-1338
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170706363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care