Provider Demographics
NPI:1972966042
Name:NANTHAVONGDOUANGSY, TONYA
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:NANTHAVONGDOUANGSY
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 1:7652 SAWMILL RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9296
Mailing Address - Country:US
Mailing Address - Phone:614-390-2764
Mailing Address - Fax:
Practice Address - Street 1:7652 SAWMILL RD
Practice Address - Street 2:SUITE 208
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9296
Practice Address - Country:US
Practice Address - Phone:614-390-2764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.401251163W00000X, 163WA2000X, 163WC0400X, 163WC1500X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health