Healthcare Provider Details

I. General information

NPI: 1124056569
Provider Name (Legal Business Name): TONY TRAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N 22ND ST
BLAIR NE
68008-1128
US

IV. Provider business mailing address

810 N 22ND ST
BLAIR NE
68008-1128
US

V. Phone/Fax

Practice location:
  • Phone: 402-426-2182
  • Fax: 402-426-1181
Mailing address:
  • Phone: 402-426-2182
  • Fax: 402-426-1181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD117138
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number53517
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: