Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 0101234899 | VA |
N | 111NI0900X | Internist | 0101234899 | VA |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 0101234899 | VA |
NPI | 1043372147 |
---|---|
Provider Name | Johanna Elizabeth Tran |
First Address | Glen Allen, VA 23059-8002 |
Second Address | Mechanicsville, VA 23116-1844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 24/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01043372147 | (05) | VA |
I01359 | (02) | VA |