Provider Demographics
NPI:1558124180
Name:SAJDYK, JESSICA DIANE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DIANE
Last Name:SAJDYK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 ESSEX DR
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:IN
Mailing Address - Zip Code:46304-9798
Mailing Address - Country:US
Mailing Address - Phone:219-718-2579
Mailing Address - Fax:
Practice Address - Street 1:1275 E NORTH ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3538
Practice Address - Country:US
Practice Address - Phone:219-661-1640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015134A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily