| Doctor Name: | MS. AMANDA TRACEY |
| NPI Number: | 1902121585 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.T. |
| License Number: | |
| Business Practice Address: | Highway 264, Milepost 388 Laboratory Polacca, AZ - 86042 |
| Business Phone Number: | 9287376220 |
| Business Fax Number: | 9287376047 |
| Mailing Address: | Po Box 4000, Laboratory POLACCA |
| State: | AZ |
| Postal Code: | 86034 |
| Phone Number: | 9287376220 |
| Fax Number: | 9287376047 |
| NPI Enumeration Date: | 04/07/2010 |
| NPI Last Update Date: | 04/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246QL0900X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Spec/Tech, Pathology |
| Taxonomy Specialization: | Laboratory Management |
| Taxonomy Definition: | |