Healthcare Provider Details

I. General information

NPI: 1467197319
Provider Name (Legal Business Name): MICHELE L KADENKO-MONIRIAN APRN-CNS AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 RANDALLIA DR
FORT WAYNE IN
46805-4699
US

IV. Provider business mailing address

14522 WATERBROOK RD
FORT WAYNE IN
46814-9141
US

V. Phone/Fax

Practice location:
  • Phone: 260-312-5083
  • Fax:
Mailing address:
  • Phone: 260-312-5083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number2811713A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number28117213A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: