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General NPI Number Information
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NPI Number | 1265063622
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Entity Type | Individual
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Provider Name | TRACEY WILLIAMS
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Gender | Female
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Dates
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Enumeration Date | 02/03/2020
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 55 S STATE AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46201-3802
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Country | US
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Telephone | 317-937-5732
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Fax |
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Provider Business Mailing Address
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Address Line | 541 FOREST AVE
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City | GREENWOOD
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State | IN
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Zip | 46143-1744
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Country | US
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Telephone | 317-937-5732
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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