Provider Demographics
NPI:1255072781
Name:TRAKAS, ALICIA JONEEN (CNM)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:JONEEN
Last Name:TRAKAS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-2945
Mailing Address - Country:US
Mailing Address - Phone:906-285-2121
Mailing Address - Fax:
Practice Address - Street 1:2314 2ND ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-2945
Practice Address - Country:US
Practice Address - Phone:906-285-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI199870-30163W00000X
CNM08536367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse