Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | R223544 | MD |
NPI | 1023555281 |
---|---|
Provider Name | Tracy Lynn Crose-Hamm |
First Address | Bel Air, MD 21014-4244 |
Second Address | Bel Air, MD 21014-4244 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2017 |
Last Update Date | 18/01/2018 |