Most Relevant Information
Provider Data
| NPI Number: | 1003204389 |
| Provider Name: | TRACY PHELAN RD |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: | 1103367 |
Most Important Dates
| Enumeration Date: | 01/08/2015 |
| Last Updated: | 01/08/2015 |
Provider Practice Location
195 BROADWAY
195 BROADWAY
NEWPORT
RI
028402610
Practice Location Phone/Fax
| Phone: | 6177560082 |
| Fax: |
Provider Mailing Location
195 BROADWAY
195 BROADWAY
NEWPORT
RI
028402610
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |