Unknown Individual – Adult Health Nurse Practitioner, NPI 1336108257

Unknown Individual is a healthcare provider. based in Fort wayne, Indiana. specializing in Adult Health Nurse Practitioner. They hold a License No. 71000590A (IN). The NPI Number for Unknown Individual is 1336108257

Main info

Organization
Inactive
41 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1336108257
Phone
(260) 479-3516
Address
6920 POINTE INVERNESS WAY STE 200
Deactivation Date
14 August 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2604322297
Graduation Year
1985 (41 years ago)
PAC ID
9931256633
Group Practice PAC ID
4981751617
Professional Enrollment ID
I20090415000634

Contacts

Secure Messaging
lucia.kroh@lutheranhealthnetwork.cernerdirect.com
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • Pointe Inverness Way, Covington Dells, Fort Wayne, Allen County, Indiana, 46804, United States

    FORT WAYNE, IN 468047934

    Phone: (260) 479-3516

    Fax: (260) 479-3520

    Type: Mailing

  • 7916, West Jefferson Boulevard, Fort Wayne, Allen County, Indiana, 46804, United States

    FORT WAYNE, IN 468044140

    Phone: (260) 432-2297

    Fax: (260) 479-2950

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 46804)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4981751617View full group profile
NameSpecialtyState
Infectious DiseaseIN
-IN
Family PracticeIN
Nurse PractitionerIN
U R O L O G YMI
Internal MedicineIN
-IN
Nurse PractitionerIN
Cardiovascular Disease (Cardiology)IN
Family PracticeIN

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1336108257 — is the standard way to identify this listing.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Adult Health Nurse Practitioner in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Fort Wayne, Indiana in our summary view.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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