Healthcare Provider Details

I. General information

NPI: 1972966042
Provider Name (Legal Business Name): TONYA NANTHAVONGDOUANGSY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7652 SAWMILL RD SUITE 208
DUBLIN OH
43016-9296
US

IV. Provider business mailing address

7652 SAWMILL RD SUITE 208
DUBLIN OH
43016-9296
US

V. Phone/Fax

Practice location:
  • Phone: 614-390-2764
  • Fax:
Mailing address:
  • Phone: 614-390-2764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.401251
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN.401251
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN.401251
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN.401251
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.401251
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: