Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 2015-01537 | NC |
Y | 208600000X | Surgeon | 2015-01537 | NC |
NPI | 1013136415 |
---|---|
Provider Name | Jacqueline Tracey |
First Address | Concord, NC 28025 |
Second Address | Concord, NC 28025-2982 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 21/09/2018 |