Provider Demographics
NPI:1164459590
Name:STENGEL, KATHRYN V (RN, CS/ANP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:V
Last Name:STENGEL
Suffix:
Gender:F
Credentials:RN, CS/ANP
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Other - Middle Name:
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Mailing Address - Street 1:1040 SIERRA DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7241
Mailing Address - Country:US
Mailing Address - Phone:317-865-8540
Mailing Address - Fax:317-865-8317
Practice Address - Street 1:11355 W 97TH LN
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9601
Practice Address - Country:US
Practice Address - Phone:219-365-5577
Practice Address - Fax:219-836-7585
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28050880A163W00000X
IN71000285A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200304170Medicaid
INM400025921Medicare PIN
INM400049725Medicare PIN