Provider Demographics
NPI:1689219354
Name:SYNESAEL, KALYN
Entity Type:Individual
Prefix:
First Name:KALYN
Middle Name:
Last Name:SYNESAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 SAGAMORE PKWY W
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1569
Mailing Address - Country:US
Mailing Address - Phone:765-204-1122
Mailing Address - Fax:765-205-8322
Practice Address - Street 1:156 SAGAMORE PKWY W
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1569
Practice Address - Country:US
Practice Address - Phone:765-204-1122
Practice Address - Fax:765-205-8322
Is Sole Proprietor?:No
Enumeration Date:2019-11-16
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28226867A163W00000X
IN71010421A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse