| NPI | 1649512542 |
|---|---|
| Former Name | TRACY MICHELLE CARLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2016-0616) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2013-0347) |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2023-09-13 |