| NPI | 1053789214 |
|---|---|
| Former Name | TRACY DIANE BURKETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000195) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA 312) |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2023-09-11 |