Provider Demographics
NPI:1598091019
Name:SINEX, SARA SUZETTE (RNMSNCNS)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:SUZETTE
Last Name:SINEX
Suffix:
Gender:F
Credentials:RNMSNCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 S ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2353
Mailing Address - Country:US
Mailing Address - Phone:812-339-1691
Mailing Address - Fax:812-337-2438
Practice Address - Street 1:831 DILLON DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-8048
Practice Address - Country:US
Practice Address - Phone:765-983-8058
Practice Address - Fax:765-983-8609
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000046A364SP0808X
IN28078531A163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN70000046AOtherAPN
IN28078531AOtherRN
IN70000046BOtherCSR PRESCRIPTIVE AUTHORITY