Individual
MARY TRACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
52 VILLAGE DR, PAGOSA SPRINGS, CO 81147-8368
(970) 264-2104
(970) 264-2108
Mailing address
8745 COUNTY ROAD 9 S, ALAMOSA, CO 81101-9610
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APN.0993060-NP
CO
Other
Enumeration date
04/08/2015
Last updated
03/17/2018
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