Provider Demographics
NPI:1639567597
Name:THONG, NANCY (NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:THONG
Suffix:
Gender:F
Credentials:NP
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:710 VETERANS MEMORIAL PKWY W
Mailing Address - Street 2:APT. #112
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-6959
Mailing Address - Country:US
Mailing Address - Phone:317-418-0687
Mailing Address - Fax:
Practice Address - Street 1:3501 WESTFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46062-8935
Practice Address - Country:US
Practice Address - Phone:765-742-1567
Practice Address - Fax:317-214-6015
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2023-05-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71005276A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100232630AMedicaid