Provider Demographics
NPI:1053501940
Name:TRANA, MARY LEANN
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LEANN
Last Name:TRANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 11TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5068
Mailing Address - Country:US
Mailing Address - Phone:563-241-4230
Mailing Address - Fax:563-519-4235
Practice Address - Street 1:2604 2ND AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5610
Practice Address - Country:US
Practice Address - Phone:563-262-0253
Practice Address - Fax:563-262-8472
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001841225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665711Medicaid
IAI21051OtherMEDICARE
IAI21051OtherMEDICARE