Individual
STEPHANIE TRACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
550 E DEVON AVE STE 200, ITASCA, IL 60143-2639
(864) 625-3376
Mailing address
550 E DEVON AVE STE 200, ITASCA, IL 60143-2639
(864) 625-3376
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-001077
IL
Other
Enumeration date
10/12/2006
Last updated
03/09/2022
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