Provider Demographics
NPI:1598216632
Name:THEPMANIVONG, CHANTHANOME
Entity type:Individual
Prefix:MRS
First Name:CHANTHANOME
Middle Name:
Last Name:THEPMANIVONG
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 1:2131 MURFREESBORO PIKE STE 209
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-6306
Mailing Address - Country:US
Mailing Address - Phone:615-400-3727
Mailing Address - Fax:
Practice Address - Street 1:2131 MURFREESBORO PIKE STE 209
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-6306
Practice Address - Country:US
Practice Address - Phone:615-400-3727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator