Provider Demographics
NPI:1891972139
Name:VERTEIN, DAREN W (FNP)
Entity Type:Individual
Prefix:
First Name:DAREN
Middle Name:W
Last Name:VERTEIN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-428-6161
Mailing Address - Fax:812-421-2883
Practice Address - Street 1:4506 1ST AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-3624
Practice Address - Country:US
Practice Address - Phone:812-428-6161
Practice Address - Fax:812-421-2883
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004862A363L00000X
KY3010032363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201217430Medicaid
IN257900039Medicare PIN
TNAPN0000016200OtherFNP
TNRN0000162544OtherRN