Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | 05006974A | IN |
NPI | 1629439278 |
---|---|
Provider Name | Jennifer Sergio |
First Address | Indianapolis, IN 46202-1252 |
Second Address | Indianapolis, IN 46202-1252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2016 |
Last Update Date | 10/03/2016 |