Provider Demographics
NPI:1477141729
Name:SAJN, MARY (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SAJN
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:KLOOTWYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP-BC
Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-392-7084
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:901 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2901
Practice Address - Country:US
Practice Address - Phone:219-703-4367
Practice Address - Fax:219-852-6473
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28170191A163WG0600X
IN71011007A363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology