| NPI | 1811084247 |
|---|---|
| Former Name | TRACY JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3300) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011336) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2024-11-15 |