Provider Demographics
NPI:1174830236
Name:SABUDA, JENNIFER J (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:J
Last Name:SABUDA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7863 BROADWAY STE 140
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5563
Mailing Address - Country:US
Mailing Address - Phone:219-769-3678
Mailing Address - Fax:219-736-5638
Practice Address - Street 1:7863 BROADWAY STE 140
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5563
Practice Address - Country:US
Practice Address - Phone:219-769-3678
Practice Address - Fax:219-736-5638
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28164729A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily