Provider Demographics
NPI:1407732357
Name:WILSON, TRACY HELANE
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:HELANE
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11807 OLD LEGISLATIVE RD SW
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-3739
Mailing Address - Country:US
Mailing Address - Phone:301-268-9304
Mailing Address - Fax:
Practice Address - Street 1:11807 OLD LEGISLATIVE RD SW
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-3739
Practice Address - Country:US
Practice Address - Phone:301-268-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program