Healthcare Provider Details

I. General information

NPI: 1013747633
Provider Name (Legal Business Name): NINA TRAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 NE 192ND AVE STE 505
VANCOUVER WA
98684-7511
US

IV. Provider business mailing address

772 SW 49TH DR
GRESHAM OR
97080-5531
US

V. Phone/Fax

Practice location:
  • Phone: 503-305-6262
  • Fax:
Mailing address:
  • Phone: 503-206-2253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10030454
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: