Individual
MRS. KATHLEEN VANDERREYDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3030 LAKE AVE STE 24, FORT WAYNE, IN 46805-5428
(260) 201-3119
(260) 233-7416
Mailing address
3030 LAKE AVE STE 24, FORT WAYNE, IN 46805-5428
(260) 201-3119
(260) 233-7416
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71009667A
IN
363L00000X
Nurse Practitioner
Primary
7100966A
IN
Other
Enumeration date
01/17/2020
Last updated
07/06/2026
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