Individual
TRACY COLLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7980 WEBSTER DR, LAMBERTVILLE, MI 48144-9618
(419) 360-0764
Mailing address
550 AMES ST, ELMORE, OH 43416-9736
(419) 360-0764
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN.CNP.020699
OH
363LG0600X
Gerontology Nurse Practitioner
AAPRN.CNP.020699
OH
Other
Enumeration date
05/11/2017
Last updated
09/15/2023
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