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General NPI Number Information
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NPI Number | 1255149951
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Entity Type | Individual
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Provider Name | MILDRED SENERIZ
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Gender | Female
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Dates
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Enumeration Date | 12/27/2024
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 1716 HARTFORD ST
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City | LAFAYETTE
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State | IN
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Zip | 47904-2173
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Country | US
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Telephone | 765-742-1567
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Fax |
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Provider Business Mailing Address
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Address Line | 407 W SOUTH ST
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City | REMINGTON
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State | IN
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Zip | 47977-8627
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Country | US
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Telephone | 317-902-2392
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28237008A
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License Number State | IN
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