Provider Demographics
NPI:1104811637
Name:BARANCYK, SNEZANA (RN FNP)
Entity type:Individual
Prefix:
First Name:SNEZANA
Middle Name:
Last Name:BARANCYK
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9660 WICKER AVENUE
Mailing Address - Street 2:
Mailing Address - City:ST JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9487
Mailing Address - Country:US
Mailing Address - Phone:219-365-1166
Mailing Address - Fax:219-365-8852
Practice Address - Street 1:9660 WICKER AVENUE
Practice Address - Street 2:
Practice Address - City:ST JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9487
Practice Address - Country:US
Practice Address - Phone:219-365-1166
Practice Address - Fax:219-365-8852
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001370A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200466450Medicaid
IN200466450Medicaid