| NPI | 1609096155 |
|---|---|
| Former Name | TRACIE MARIE AMBROSE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY 2433621) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 172V00000X Community Health Worker (Licence: NY 243362-1) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2008-08-26 |