Individual
EMILY TRACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
172 SIESTA CIR, EVERGREEN, CO 80439-4339
(720) 940-0208
Mailing address
2011 4TH ST, LA GRANDE, OR 97850-2511
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
11/05/2020
Last updated
03/03/2022
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