| NPI | 1497894182 |
|---|---|
| Former Name | TRACY JENNIFER WANNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: MA 232186) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD P19141) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2015-01-22 |