| NPI | 1669467379 |
|---|---|
| Former Name | TRACY LYNN LAWRENCE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 057661) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35081121) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2007-07-08 |