Healthcare Provider Details

I. General information

NPI: 1164352043
Provider Name (Legal Business Name): TAMMY THI TRAN BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NW 114TH ST
CLIVE IA
50325-7007
US

IV. Provider business mailing address

8018 DELLWOOD DR
URBANDALE IA
50322-4439
US

V. Phone/Fax

Practice location:
  • Phone: 515-222-7474
  • Fax:
Mailing address:
  • Phone: 515-864-9949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number165623
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: