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Individual

TRACIE WARREN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
8740 RIVERS AVE, NORTH CHARLESTON, SC 29406-9211
(843) 572-5990
Mailing address
8740 RIVERS AVE, NORTH CHARLESTON, SC 29406-9211
(843) 572-5990

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2088
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2137PA
SC
Enumeration date
09/20/2006
Last updated
11/20/2015
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