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General NPI Number Information
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NPI Number | 1386192151
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Entity Type | Individual
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Provider Name | MARY LOU TONGAY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/21/2016
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Last Update Date | 05/03/2018
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Provider Practice Location Address
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Address Line | 4800 OAK RIDGE TRL
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City | PARK HILLS
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State | MO
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Zip | 63601-8224
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Country | US
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Telephone | 573-315-9567
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Fax |
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Provider Business Mailing Address
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Address Line | 111 W PORT PLZ STE 600
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3015
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Country | US
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Telephone | 480-862-1677
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2016032820
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License Number State | MO
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