Individual
TRACY MAHON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1609 W 3RD AVE, WILLIAMSON, WV 25661-3006
(304) 235-0026
Mailing address
1535 W 4TH AVE APT 2, WILLIAMSON, WV 25661-3412
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
25675
WV
Other
Enumeration date
04/14/2007
Last updated
07/08/2007
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