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 |