Individual
TRACY L JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
709 MULBERRY DR W, WEST BEND, WI 53090-2257
(262) 483-2637
Mailing address
709 MULBERRY DR W, WEST BEND, WI 53090-2257
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
161173-030
WI
Other
Enumeration date
12/28/2010
Last updated
12/28/2010
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