Individual
TRACY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1006 BERN CIRCLE, ANDERSON, SC 29626
(864) 245-7881
Mailing address
1006 BERN CIRCLE, ANDERSON, SC 29626
(864) 245-7881
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
31634
SC
Other
Enumeration date
11/09/2020
Last updated
11/09/2020
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