Healthcare Provider Details

I. General information

NPI: 1104640523
Provider Name (Legal Business Name): KAITLYNN SAXE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRANT ST
GARY IN
46402-6001
US

IV. Provider business mailing address

600 GRANT ST
GARY IN
46402-6001
US

V. Phone/Fax

Practice location:
  • Phone: 219-886-4710
  • Fax:
Mailing address:
  • Phone: 219-886-4710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28271085A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: