Healthcare Provider Details

I. General information

NPI: 1962175737
Provider Name (Legal Business Name): LOAN TRUONG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-5302
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-1285
  • Fax:
Mailing address:
  • Phone: 409-772-2222
  • Fax: 409-772-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1038724
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1038724
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1038724
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: