| NPI | 1407076789 |
|---|---|
| Other Name | TRACY LEE DISTEFANO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01020300) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: PA rn349942l) |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2020-02-27 |