Provider Demographics
NPI:1386192151
Name:TONGAY, MARY LOU (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LOU
Last Name:TONGAY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W PORT PLZ
Mailing Address - Street 2:STE 600
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3015
Mailing Address - Country:US
Mailing Address - Phone:480-862-1677
Mailing Address - Fax:
Practice Address - Street 1:4800 OAK RIDGE TRL
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-8224
Practice Address - Country:US
Practice Address - Phone:573-315-9567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016032820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily