Doctor Name: | MRS. DARLA K. TRACY |
NPI Number: | 1386908549 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CPHA |
License Number: | 041-194691 |
Business Practice Address: | 202 N Bline Blvd Robinson, IL - 624541264 |
Business Phone Number: | 6185448798 |
Business Fax Number: | |
Mailing Address: | 7712 E Westlake Dr, ROBINSON |
State: | IL |
Postal Code: | 624544879 |
Phone Number: | 6185449273 |
Fax Number: | |
NPI Enumeration Date: | 07/02/2012 |
NPI Last Update Date: | 07/02/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WA2000X |
License Number: | 041-194691 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Administrator |
Taxonomy Definition: |