Provider Demographics
NPI:1174316962
Name:THACH, TRA THI
Entity type:Individual
Prefix:
First Name:TRA
Middle Name:THI
Last Name:THACH
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 1:1549 W LANDER DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-6665
Mailing Address - Country:US
Mailing Address - Phone:402-802-2885
Mailing Address - Fax:
Practice Address - Street 1:1549 W LANDER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-6665
Practice Address - Country:US
Practice Address - Phone:402-802-2885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide