Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | NVMT.6874 | NV |
NPI | 1558751461 |
---|---|
Provider Name | Angela Tracy |
First Address | Las Vegas, NV 89166-8051 |
Second Address | Las Vegas, NV 89166-8051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2015 |
Last Update Date | 29/01/2015 |