Healthcare Provider Details

I. General information

NPI: 1386331387
Provider Name (Legal Business Name): HUY NGUYEN TRAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S 16TH ST STE 410
LINCOLN NE
68502-3785
US

IV. Provider business mailing address

7337 S 30TH ST
LINCOLN NE
68516-4875
US

V. Phone/Fax

Practice location:
  • Phone: 402-475-1511
  • Fax: 402-474-1611
Mailing address:
  • Phone: 402-875-1399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2904
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: