Individual
MRS. TRACY WEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-6208
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-6208
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
081272
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
081272
GEORGIA LICENCE
GA
Enumeration date
09/09/2014
Last updated
09/09/2014
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