Provider Demographics
NPI:1467197319
Name:KADENKO-MONIRIAN, MICHELE L (APRN-CNS AGCNS-BC)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:L
Last Name:KADENKO-MONIRIAN
Suffix:
Gender:F
Credentials:APRN-CNS AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14522 WATERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9141
Mailing Address - Country:US
Mailing Address - Phone:260-312-5083
Mailing Address - Fax:
Practice Address - Street 1:2200 RANDALLIA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4699
Practice Address - Country:US
Practice Address - Phone:260-312-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2811713A364SC0200X
IN28117213A364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine