Individual
TRACY ANN IVERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
210 W WALNUT ST, CANTON, IL 61520-2444
(309) 647-0201
Mailing address
724 E CARROLL ST, MACOMB, IL 61455-2454
(309) 313-4801
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209029712
IL
Other
Enumeration date
05/17/2024
Last updated
05/20/2024
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