Healthcare Provider Details

I. General information

NPI: 1801354303
Provider Name (Legal Business Name): THAO TRAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4879 E KINGS CANYON RD
FRESNO CA
93727-3811
US

IV. Provider business mailing address

4879 E KINGS CANYON RD
FRESNO CA
93727-3811
US

V. Phone/Fax

Practice location:
  • Phone: 559-255-8395
  • Fax:
Mailing address:
  • Phone: 559-255-8395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: