Basic Information
| Provider Information | |||||||||
| NPI: | 1396240313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5533 MOUNTAIN VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | THE COLONY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750563798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722613257 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2409 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787121112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124711737 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2018 | ||||||||
| LastUpdateDate: | 03/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.