Healthcare Provider Details

I. General information

NPI: 1023766490
Provider Name (Legal Business Name): KIA DENAE HRENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2087 ACORN BLVD
FRANKLIN IN
46131-7306
US

IV. Provider business mailing address

56 SUNSET MNR
MOORESVILLE IN
46158-1249
US

V. Phone/Fax

Practice location:
  • Phone: 317-738-8095
  • Fax:
Mailing address:
  • Phone: 317-518-9677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: