Individual
TRACEY WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
785 RUSSELL ST, CRAIG, CO 81625-2019
(970) 826-2300
Mailing address
785 RUSSELL ST, CRAIG, CO 81625-2019
(970) 826-2300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2454
CO
Other
Enumeration date
08/14/2007
Last updated
04/12/2017
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