Provider Demographics
NPI:1053711150
Name:TRAHAN, LAURIE (RTT (R)(T))
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:RTT (R)(T)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 LONE OAK DR
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:TN
Mailing Address - Zip Code:38028-3367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:435 LONE OAK DR
Practice Address - Street 2:
Practice Address - City:EADS
Practice Address - State:TN
Practice Address - Zip Code:38028-3367
Practice Address - Country:US
Practice Address - Phone:901-848-7826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2368042471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy