Provider Demographics
NPI:1255149951
Name:SENERIZ, MILDRED
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:SENERIZ
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 1:407 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:REMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47977-8627
Mailing Address - Country:US
Mailing Address - Phone:317-902-2392
Mailing Address - Fax:
Practice Address - Street 1:1716 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2173
Practice Address - Country:US
Practice Address - Phone:765-742-1567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28237008A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily