Provider Demographics
NPI:1659058923
Name:TRANT, TEAGAN DANIELLE
Entity Type:Individual
Prefix:
First Name:TEAGAN
Middle Name:DANIELLE
Last Name:TRANT
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 1:111 JUDIQUE RD
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1380
Mailing Address - Country:US
Mailing Address - Phone:978-944-8579
Mailing Address - Fax:
Practice Address - Street 1:111 JUDIQUE RD
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-1380
Practice Address - Country:US
Practice Address - Phone:978-944-8579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2373803163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse