Individual
NHANHIEN D TRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1317 S DEWEY AVE, WAGONER, OK 74467-7013
(918) 485-9696
(918) 485-1701
Mailing address
509 NW 9TH ST, WAGONER, OK 74467-2305
(316) 516-4895
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1501107
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110990040
MEDICARE (VIA CHRIST)
—
05
—
200739590A
—
KS
01
—
OKB0019
MEDICARE GROUP PTAN
OK
Enumeration date
03/30/2007
Last updated
04/06/2015
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