Individual
TRACY ANN VIDETTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
27 JACKSON ST APT 213, LOWELL, MA 01852-2140
(617) 697-2721
Mailing address
27 JACKSON ST APT 213, LOWELL, MA 01852-2140
(617) 697-2721
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN2299729
MA
Other
Enumeration date
10/13/2021
Last updated
10/13/2021
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