Provider Demographics
NPI:1639647381
Name:TRAHAN, NETTA
Entity Type:Individual
Prefix:
First Name:NETTA
Middle Name:
Last Name:TRAHAN
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 1:8200 WEDNESBURY LN # 317
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2925
Mailing Address - Country:US
Mailing Address - Phone:346-352-0725
Mailing Address - Fax:346-352-0729
Practice Address - Street 1:8200 WEDNESBURY LN STE 317
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2925
Practice Address - Country:US
Practice Address - Phone:346-352-0725
Practice Address - Fax:346-352-0729
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17312812246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy