Individual
TRACY LYNN NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2329 GRIFFIN RD SW, ALBUQUERQUE, NM 87105-7026
(505) 377-6110
Mailing address
805 TIJERAS AVE NW, ALBUQUERQUE, NM 87102-3099
(505) 269-0486
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/29/2019
Last updated
07/29/2019
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