Individual
MRS. PAMELA S DEKONINCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RN, AGPCNP-BC
Contact information
Practice address
2101 E COLISEUM BLVD, WU 234, FORT WAYNE, IN 46805-1445
(260) 481-5748
(260) 481-5752
Mailing address
2101 E COLISEUM BLVD, WU 234, FORT WAYNE, IN 46805-1445
(260) 481-5748
(260) 481-5752
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
28079817
IN
Other
Enumeration date
07/25/2016
Last updated
07/25/2016
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