Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 64564-20 | WI |
N | 2081P2900X | Pain Medicine | 40852 | AZ |
N | 2081S0010X | Sports Medicine | 40852 | AZ |
N | 213ES0000X | Sports Medicine | 40852 | AZ |
NPI | 1093972754 |
---|---|
Provider Name | Dr. Tracy Louise Page |
First Address | Appleton, WI 54913-8559 |
Second Address | Appleton, WI 54913-8559 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2008 |
Last Update Date | 02/06/2021 |