| NPI | 1174874861 |
|---|---|
| Former Name | TRACIE KOEBCKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 2417) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085004390) |
| Enumeration Date | 2012-09-21 |
| Last Update Date | 2018-07-18 |