Individual
TRACY VITANTONIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(800) 584-7888
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(800) 584-7888
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
20912983
IL
Other
Enumeration date
05/06/2015
Last updated
08/02/2015
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