Healthcare Provider Details

I. General information

NPI: 1114067378
Provider Name (Legal Business Name): HOA TUYET TRAN-BALK RD, LMNT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 DODGE ST
OMAHA NE
68114-4108
US

IV. Provider business mailing address

12676 FOWLER AVE
OMAHA NE
68164-1998
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-4079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number748
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: