Healthcare Provider Details

I. General information

NPI: 1962146555
Provider Name (Legal Business Name): SARA DEANN KATUZIENSKI RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 E DISCOVERY PKWY RM 4077
BLOOMINGTON IN
47408-9059
US

IV. Provider business mailing address

8577 S GORE RD
BLOOMINGTON IN
47403-8806
US

V. Phone/Fax

Practice location:
  • Phone: 623-850-6068
  • Fax:
Mailing address:
  • Phone: 623-850-6068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number28104845A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: