| NPI | 1790136554 |
|---|---|
| Former Name | TRACY ANN RIESENBERGER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C08878) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0001081) |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA60805561) | |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2024-07-12 |