Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. John S Inthavongsa, DNPRNAGACNP-BC

Individual provider Registered Nurse · NPI 1588220222

Dr. John S Inthavongsa, DNPRNAGACNP-BC is a Nurse Practitioner in Detroit, Michigan. Graduated from University of Michigan Medical School in 2019, 7 years ago. Practices with New York University, a 5,884-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
7
Trained at
University of Michigan Medical School
Licensed in
MI
In the registry since
2019
Specialties on file
2
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Practice location Address checks out

4201 Saint Antoine St
Detroit, MI 48201-2153
Phone: (313) 745-3000
Fax: (313) 745-4707
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 454 W Alexandrine St Apt 18, Detroit, MI 48201-1787 — (347) 963-1896

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence 4704309696 (MI)
Registered Nurse Taxonomy 163W00000X · Licence 4704309696 (MI)

Record details

NPI number1588220222
Entity typeIndividual (Type 1)
GenderMale
Credentials DNPRNAGACNP-BC
Sole proprietorYes
NPI enumeratedMay 17, 2019
Last updated in NPPESJune 4, 2021
Certification dateJune 4, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolUNIVERSITY OF MICHIGAN MEDICAL SCHOOL
Graduated 2019 (7 years in practice)
Group practice New York University — 5884 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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