Healthcare Provider Details

I. General information

NPI: 1912142548
Provider Name (Legal Business Name): KRISTIN MARIE GICK NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN MARIE DENO

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 61ST AVE
HOBART IN
46342-6449
US

IV. Provider business mailing address

PO BOX 781076 SIGMA MEDICAL GROUP
DETROIT MI
48278-2099
US

V. Phone/Fax

Practice location:
  • Phone: 765-423-6224
  • Fax: 765-423-6910
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN 28120649 A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP 71002804 A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: