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General NPI Number Information
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NPI Number | 1477141729
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Entity Type | Individual
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Provider Name | MARY SAJN AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 12/16/2022
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Provider Practice Location Address
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Address Line | 901 MACARTHUR BLVD
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City | MUNSTER
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State | IN
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Zip | 46321-2901
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Country | US
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Telephone | 219-703-4367
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Fax | 219-852-6473
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Provider Business Mailing Address
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Address Line | 8558 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7032
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Country | US
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Telephone | 219-392-7084
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Fax | 219-703-6854
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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 | 163WG0600X
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Taxonomy Name | Gerontology Registered Nurse
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License Number | 28170191A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 71011007A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 71011007A
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License Number State | IN
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