Provider Demographics
NPI:1689009193
Name:PROSNIAK, SIZHU (APN)
Entity type:Individual
Prefix:MISS
First Name:SIZHU
Middle Name:
Last Name:PROSNIAK
Suffix:
Gender:
Credentials:APN
Other - Prefix:
Other - First Name:SIZHU
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8233 GLENCARIN BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5784
Practice Address - Country:US
Practice Address - Phone:260-425-5470
Practice Address - Fax:260-425-5475
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016746363LP2300X
IN71012550A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care