Provider Demographics
NPI:1124056569
Name:TRAN, TONY (CRNA)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-1128
Mailing Address - Country:US
Mailing Address - Phone:402-426-2182
Mailing Address - Fax:402-426-1181
Practice Address - Street 1:810 N 22ND ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1128
Practice Address - Country:US
Practice Address - Phone:402-426-2182
Practice Address - Fax:402-426-1181
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD117138367500000X
NE53517367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098713OtherMEDICARE-IMC/BERGAN
NE47055043815Medicaid
NE10025507900Medicaid
NE10025745800Medicaid
NENA1324OtherMEDICARE-MIDLANDS
IAI21224OtherMEDICARE-MERCY
NE098713OtherMEDICARE-BERGAN
NE10025709800Medicaid