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Tracey L Dovi

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

2801 W Kinnickinnic River Pkwy, Suite 840, Milwaukee, WI 53215-3669

PECOS Enrollment

This provider is enrolled in PECOS as TRACEY DOVI.

Based on the most recent information from CMS, provider Tracey L Dovi is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1417120825
Provider Type
Individual
Full Name
Dovi, Tracey L
Credential
APNP

Gender
Female
Sole Proprietor
No
Enumeration Date
4/7/2008
Last Updated
12/1/2021

Contact Information

Practice Location

2801 W Kinnickinnic River Pkwy, Suite 840, Milwaukee, WI 53215-3669

(414) 649-3530

(414) 649-3529

Mailing Location

2801 W Kinnickinnic River Pkwy, Suite 840, Milwaukee, WI 53215-3669

(414) 649-3530

(414) 649-3529

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 3407 Wisconsin
Code 363LA2200X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 3407-33 Wisconsin

Provider Identifiers

ID	Description	Issuer
ID 36061700	Description Medicaid	Issuer Unlisted Wisconsin

Tracey L Dovi

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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Germanotta, Margaret Anne

Bellanger, Cynthia

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Diaz, Jordan A