Pamela S Dekoninck, MS, RN, AGPCNP-BC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

28079817 Issued in IN

Practice address

2101 E Coliseum Blvd
Wu 234
Fort Wayne, IN 46805-1445

Phone

(260) 481-5748

Fax

(260) 481-5752

NPI assigned

Jul 25, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science, Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lutheran Medical Group LLC

  • Cardiovascular Disease Physician
  • Fort Wayne, IN
  • NPI 1164662805
  NPD (past)
• Purdue University

  • Clinic/Center
  • Fort Wayne, IN
  • NPI 1679917710
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469404800000",
    "number": "1639622772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 E COLISEUM BLVD",
            "address_2": "WU 234",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468051445",
            "telephone_number": "260-481-5748",
            "fax_number": "260-481-5752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 E COLISEUM BLVD",
            "address_2": "WU 234",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468051445",
            "telephone_number": "260-481-5748",
            "fax_number": "260-481-5752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEKONINCK",
        "first_name": "PAMELA",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "credential": "MS, RN, AGPCNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-25",
        "last_updated": "2016-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "28079817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abby Dehoff
• Benjamin Dehr
• Jenna Deininger, PHARMD, RPH
• Julie Suzanne Dejesus, LMHCA
• Matthew R Dejesus
• Aleea Del Cid
• Susan Delagrange, RDCD
• Rachel Delamarter
• Charlene Delaney, MT-BC
• Sarah Delaney, AUD

• Gerontology Nurse Practitioner in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Gerontology Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.