Most Relevant Information
Provider Data
| NPI Number: | 1003431347 |
| Provider Name: | TRACEY OLIVIA GREEN |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/12/2020 |
| Last Updated: | 06/12/2020 |
Provider Practice Location
1324 RIDGE PL SE
WASHINGTON
DC
200206924
Practice Location Phone/Fax
| Phone: | 2023446853 |
| Fax: |
Provider Mailing Location
1324 RIDGE PL SE
WASHINGTON
DC
200206924
Provider Mailing Phone/Fax
| Phone: | 2023446853 |
| Fax: |