Individual
TRACY GILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
20 GRAPE ST, FAIRHAVEN, MA 02719-1616
(508) 740-0437
Mailing address
20 GRAPE ST, FAIRHAVEN, MA 02719-1616
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN238805
MA
Other
Enumeration date
04/07/2026
Last updated
04/07/2026
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