Healthcare Provider Details

I. General information

NPI: 1124937826
Provider Name (Legal Business Name): LOAN TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 BURT ST SE
WYOMING MI
49548-3261
US

IV. Provider business mailing address

356 BURT ST SE
WYOMING MI
49548-3261
US

V. Phone/Fax

Practice location:
  • Phone: 616-920-4214
  • Fax:
Mailing address:
  • Phone: 616-920-4214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: