| NPI | 1821026170 |
|---|---|
| Former Name | JENNIFER ELAINE TRACY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12024) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 1588) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2021-03-29 |