KRISTEN CONWAY FAKES

RENSSELAER, IN
NPI1578349965
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363LG0600X Nurse Practitioner, Gerontology
(Licence: IN  71014561A)
Additional Taxonomies363L00000X Nurse Practitioner
(Licence: IN  28240075A)
Enumeration Date2023-09-01
Last Update Date2023-12-18
Business Address
KRISTEN CONWAY FAKES
1104 E GRACE ST
RENSSELAER, IN 47978-3211
Phone number: 219-866-5141
Mailing Address
KRISTEN CONWAY FAKES
PO BOX 781076
DETROIT, MI 48278-1076
Phone number: 317-528-4800