| Doctor Name: | TRACY L DYSARD |
| NPI Number: | 1053385344 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 041-265219 |
| Business Practice Address: | 1010 Fairway Dr Freeport, IL - 610326600 |
| Business Phone Number: | 8155997790 |
| Business Fax Number: | |
| Mailing Address: | 421 W Exchange St, Po Box 268 FREEPORT |
| State: | IL |
| Postal Code: | 610324030 |
| Phone Number: | 8155997958 |
| Fax Number: | |
| NPI Enumeration Date: | 02/14/2006 |
| NPI Last Update Date: | 03/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 041-265219 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |