Individual
TRACIE LANE STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
HWY 160 MP 394.3, KAYENTA, AZ 86033-0368
(928) 697-4100
Mailing address
PO BOX 368, KAYENTA, AZ 86033-0368
(928) 697-4100
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
R82687
AR
Other
Enumeration date
07/14/2020
Last updated
07/14/2020
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