Unknown Individual – Nurse Practitioner, NPI 1609334382

Unknown Individual is a healthcare provider. based in Fort wayne, Indiana. specializing in Nurse Practitioner. They hold a License No. RN28151055A (IN). The NPI Number for Unknown Individual is 1609334382

Main info

Organization
Inactive
7 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1609334382
Phone
(260) 447-8982
Address
1330 N COLISEUM BLVD
Deactivation Date
21 January 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3179250653
Graduation Year
2019 (7 years ago)
PAC ID
1355676560
Group Practice PAC ID
6608828181
Professional Enrollment ID
I20190710002837
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Loading map...

Provider Addresses for Unknown Individual

  • 1330, North Coliseum Boulevard, Fort Wayne, Allen County, Indiana, 46805, United States

    FORT WAYNE, IN 468055526

    Phone: (260) 447-8982

    Fax: (260) 447-4483

    Type: Location

  • 2520, Bosworth Drive, Brentwood Park, Fort Wayne, Allen County, Indiana, 46805, United States

    FORT WAYNE, IN 468053027

    Phone: (260) 418-7419

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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 46805)

Loading plans...

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: 6608828181View full group profile
NameSpecialtyState
-IN
-KY
Nurse PractitionerIN
A N E S T H E S I O L O G YIN
Nurse PractitionerIN
Physician AssistantIN
Physician AssistantIN
Nurse PractitionerMI
Diagnostic RadiologyIN

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1609334382.
What happens when Unknown Individual's NPI is not active?
Public data lists Unknown Individual outside the active bucket for this identifier.
How should patients interpret Unknown Individual's specialty?
The extract shows Nurse Practitioner for Unknown Individual. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Fort Wayne, Indiana in registry-derived data.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

Similar Providers

FORT WAYNE ORTHOPAEDICS LLC

Orthopaedic Surgery Physician
2526, Sheridan Road, Sunnymede Woods, Fort Wayne, Allen County, Indiana, 46803, United States
NPI: 1497758429

KAREN E. SPRINGER (NP)

Nurse Practitioner
7956, West Jefferson Boulevard, Brierwood Hills, Fort Wayne, Allen County, Indiana, 46804, United States
NPI: 1225035421

BEATRICE K TROXELL (NP)

Nurse Practitioner
11109 PARKVIEW PLAZA DR # 117
NPI: 1376542126

REGINALD L HUMPHREY (NP)

Nurse Practitioner
3702 NEW VISION DR BLDG B
NPI: 1619978178

JOYCE A FISHER (NP)

Nurse Practitioner
11109 PARKVIEW PLAZA DR # 117
NPI: 1962404392

VALERIE L STUCKY (NP)

Nurse Practitioner
10021, Dupont Circle Court, Fort Wayne, Allen County, Indiana, 46825, United States
NPI: 1750373601

ELLEN N UNDERWOOD (NP)

Family Nurse Practitioner
1234, East Dupont Road, Fort Wayne, Allen County, Indiana, 46825, United States
NPI: 1508858598

JULIE ANN GARRARD HALL (NP)

Family Nurse Practitioner
7956, West Jefferson Boulevard, Fort Wayne, Allen County, Indiana, 46804, United States
NPI: 1093707770