Provider Demographics
NPI:1154574473
Name:ZGORKA, CHRISTINE MARIE (MS)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:ZGORKA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9813 CRIMSON TREE LN
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4112
Mailing Address - Country:US
Mailing Address - Phone:219-924-3307
Mailing Address - Fax:
Practice Address - Street 1:3210 WATLING ST # 8-210
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-1716
Practice Address - Country:US
Practice Address - Phone:219-399-6067
Practice Address - Fax:219-399-5814
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28071763A163WX0106X
IN70000148A364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health