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General NPI Number Information
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NPI Number | 1346002672
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Entity Type | Individual
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Provider Name | KIRSTEN ELISE LENGACHER PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 2700 LAFAYETTE ST STE 110
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City | FORT WAYNE
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State | IN
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Zip | 46806-1100
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Country | US
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Telephone | 260-266-0780
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Fax |
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Provider Business Mailing Address
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Address Line | 2429 DODGE AVE
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City | FORT WAYNE
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State | IN
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Zip | 46805-3831
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Country | US
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Telephone | 517-898-1392
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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