Provider Demographics
NPI:1922443266
Name:TRAN, DENISE DIEP THI (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:DIEP THI
Last Name:TRAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:DIEP THI
Other - Last Name:TRAN-BOELZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5517
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-5517
Mailing Address - Country:US
Mailing Address - Phone:907-212-5165
Mailing Address - Fax:907-212-0950
Practice Address - Street 1:1200 W NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3652
Practice Address - Country:US
Practice Address - Phone:907-212-5165
Practice Address - Fax:907-212-0950
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0990240-NP363LF0000X
AKAPN112166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily