Healthcare Provider Details

I. General information

NPI: 1104811637
Provider Name (Legal Business Name): SNEZANA BARANCYK RN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9660 WICKER AVENUE
ST JOHN IN
46373-9487
US

IV. Provider business mailing address

9660 WICKER AVENUE
ST JOHN IN
46373-9487
US

V. Phone/Fax

Practice location:
  • Phone: 219-365-1166
  • Fax: 219-365-8852
Mailing address:
  • Phone: 219-365-1166
  • Fax: 219-365-8852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001370A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: