Provider Demographics
NPI:1346002672
Name:LENGACHER, KIRSTEN ELISE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:ELISE
Last Name:LENGACHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:ELISE
Other - Last Name:VANWIEREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2429 DODGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-3831
Mailing Address - Country:US
Mailing Address - Phone:517-898-1392
Mailing Address - Fax:
Practice Address - Street 1:2700 LAFAYETTE ST STE 110
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46806-1100
Practice Address - Country:US
Practice Address - Phone:260-266-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical