Individual
TRACY MARIE DAVISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 OLD AIRPORT RD, ELIM, AK 99739
(907) 890-3311
(907) 890-2280
Mailing address
101 OLD AIRPORT RD, ELIM, AK 99739
(907) 890-3311
(907) 890-2280
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
03-634-P
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03-634-P
CHP
AK
Enumeration date
03/26/2013
Last updated
03/26/2013
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