Basic Information
| Provider Information | |||||||||
| NPI: | 1164459590 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STENGEL | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | V. | ||||||||
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| Credential: | RN, CS/ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 SIERRA DRIVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461437241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178658540 | ||||||||
| FaxNumber: | 3178658317 | ||||||||
| Practice Location | |||||||||
| Address1: | 11355 W 97TH LN | ||||||||
| Address2: | |||||||||
| City: | SAINT JOHN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463739601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193655577 | ||||||||
| FaxNumber: | 2198367585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 07/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 28050880A | IN | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 71000285A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 200304170 | 05 | IN | MEDICAID |