MEDICARE: MR. JODY G TRAHAN RN, CNOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	597248	TX
2	163WR0006X	Registered Nurse First Assistant	597248	TX
3	246ZS0410X	Surgical Technologist	597248	TX

General Provider Information

NPI Number	:	1770612731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JODY G TRAHAN RN, CNOR

Provider Business Mailing Address
First Line	:	17424 W GRAND PKWY S # 122
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-2564
Country	:	US
Telephone Number	:	409-673-1128
Fax Number	:	866-360-3539

Provider Business Practice Location Address
First Line	:	17424 W GRAND PKWY S # 122
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-2564
Country	:	US
Telephone Number	:	409-673-1128
Fax Number	:	866-360-3539

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	04/28/2014

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