Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 35075468 | OH |
NPI | 1174617203 |
---|---|
Provider Name | Tracy Katherine Wick |
First Address | Dayton, OH 45415-1185 |
Second Address | Dayton, OH 45415-1185 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |