Doctor Name: | MRS. JOANN M TRACY |
NPI Number: | 1205814662 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PAC |
License Number: | PA10003597 |
Business Practice Address: | 915 Ne Valley Rd Pullman, WA - 99163 |
Business Phone Number: | 5093323548 |
Business Fax Number: | 5093325253 |
Mailing Address: | 915 Ne Valley Rd, PULLMAN |
State: | WA |
Postal Code: | 991633845 |
Phone Number: | 5093323548 |
Fax Number: | 5093325253 |
NPI Enumeration Date: | 01/05/2006 |
NPI Last Update Date: | 09/02/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA10003597 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |