Individual
KIERAN L PENNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
9660 WICKER AVENUE, 2ND FLOOR, ST JOHN, IN 46373-9487
(219) 226-2380
(219) 226-2381
Mailing address
9660 WICKER AVENUE, 2ND FLOOR, ST JOHN, IN 46373-9487
(219) 226-2380
(219) 226-2381
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
71001464A
IN
363LP0200X
Pediatric Nurse Practitioner
Primary
71001464A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200932310
—
IN
Enumeration date
10/11/2006
Last updated
06/23/2010
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