Individual
KRISTEN DETTMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
11115 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 266-5400
(260) 425-5715
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
28210703A
IN
363L00000X
Nurse Practitioner
Primary
28210703A
IN
Other
Enumeration date
04/24/2024
Last updated
09/03/2024
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