MEDICARE: LISEDA SERGILE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	28276951A	IN

General Provider Information

NPI Number	:	1760315824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISEDA SERGILE

Provider Business Mailing Address
First Line	:	2889 HEPBURN CIR
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-5703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2889 HEPBURN CIR
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-5703
Country	:	US
Telephone Number	:	765-485-1306
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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Directions to “ LISEDA SERGILE ” Practice Location

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