Provider Demographics
NPI:1912142548
Name:DENO, KRISTIN MARIE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MARIE
Last Name:DENO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 SALEM STREET, STE 302
Mailing Address - Street 2:SIGMA MEDICAL GROUP
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2099
Mailing Address - Country:US
Mailing Address - Phone:765-449-2410
Mailing Address - Fax:765-742-8607
Practice Address - Street 1:1501 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2134
Practice Address - Country:US
Practice Address - Phone:765-449-5080
Practice Address - Fax:765-742-8607
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRN 28120649 A363LA2200X
INNP 71002804 A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health