| NPI | 1760931604 |
|---|---|
| Professional Name | TRACY PRIMUS-BLACKMON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH LPN.143750.MEDS-IV) |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2016-10-03 |