Healthcare Provider Details

I. General information

NPI: 1952881187
Provider Name (Legal Business Name): SYLVIA BORES SAXENA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 HARTFORD ST.
LAFAYETTE IN
47904-2138
US

IV. Provider business mailing address

1716 HARTFORD ST.
LAFAYETTE IN
47904-2138
US

V. Phone/Fax

Practice location:
  • Phone: 765-742-1567
  • Fax:
Mailing address:
  • Phone: 765-742-1567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28204230A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: