Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 71006636A | IN |
NPI | 1629529334 |
---|---|
Provider Name | Tracy Kerzan |
First Address | Vincennes, IN 47591-1038 |
Second Address | Vincennes, IN 47591-1038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2016 |
Last Update Date | 23/11/2016 |