SearchIdaho133V00000X

Tracy Green, R.D

NPI 1710391669 · on the registry since 2014 · sole proprietor

Practice

Address
705 Ebony St
Pocatello, ID 83201
Phone
(208) 221-9085

Registry record

Primary taxonomy
133V00000X
133V00000X
Licence states on file
ID
From the registry's licence fields, which are often incomplete.
Sex
Female
Record last updated
2014-06-19

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Idaho