Healthcare Provider Details

I. General information

NPI: 1659068898
Provider Name (Legal Business Name): KRISTINA DARLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/19/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1496 W HOOSIER BLVD
PERU IN
46970-3727
US

IV. Provider business mailing address

1496 W HOOSIER BLVD
PERU IN
46970-3727
US

V. Phone/Fax

Practice location:
  • Phone: 765-472-5014
  • Fax:
Mailing address:
  • Phone: 765-472-5014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number27059659A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: