Individual
TRACIE MCCLARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2432 VANNESS ST, PORT HURON, MI 48060-6877
(248) 979-0109
Mailing address
2432 VANNESS ST, PORT HURON, MI 48060-6877
(248) 979-0109
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703065884
MI
Other
Enumeration date
08/19/2016
Last updated
08/19/2016
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