| NPI | 1962603530 |
|---|---|
| Former Name | TRACY TAGGART WIESBERG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR 27912) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA MD-48236) |
| 208600000X Surgery (Licence: WA MD60957762) | |
| 208600000X Surgery (Licence: CA C175274) | |
| 2086S0127X Surgery Trauma Surgery (Licence: IA MD-48236) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2025-08-22 |