Basic Information
Provider Information
NPI: 1215418355
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TANSY
FirstName: ELENA
MiddleName: CHRISTINE
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6626 E 75TH ST STE 500
Address2:  
City: INDIANAPOLIS
State: IN
PostalCode: 462502890
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 3500 S LAFOUNTAIN ST
Address2:  
City: KOKOMO
State: IN
PostalCode: 469023803
CountryCode: US
TelephoneNumber: 7657763500
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/27/2018
LastUpdateDate: 10/31/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/31/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X28167994AINY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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