Healthcare Provider Details

I. General information

NPI: 1255149951
Provider Name (Legal Business Name): MILDRED SENERIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MICHIGAN AVE STE 270
LOGANSPORT IN
46947-1530
US

IV. Provider business mailing address

407 W SOUTH ST
REMINGTON IN
47977-8627
US

V. Phone/Fax

Practice location:
  • Phone: 574-722-4921
  • Fax: 574-739-0520
Mailing address:
  • Phone: 317-902-2392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71016215A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: