Provider Demographics
NPI:1235401381
Name:TUNNY, DEBORAH L (NP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:TUNNY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8920 SOUTHPOINTE DR
Practice Address - Street 2:SUITE D2
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227
Practice Address - Country:US
Practice Address - Phone:317-621-1006
Practice Address - Fax:317-355-6822
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28157241A163W00000X
IN71003868A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201062910Medicaid
IN000000784050OtherANTHEM
INP01239093OtherMEDICARE RR PTAN
IN000000784050OtherANTHEM