Provider Demographics
NPI:1770037244
Name:DAHL, TRACI
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:DAHL
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 1:6257 LACOMB ROAD
Mailing Address - Street 2:TRACI DAHL
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707
Mailing Address - Country:US
Mailing Address - Phone:989-255-8066
Mailing Address - Fax:
Practice Address - Street 1:6257 LACOMB ROAD
Practice Address - Street 2:TRACI DAHL
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-9736
Practice Address - Country:US
Practice Address - Phone:989-255-8066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other