MEDICARE: MRS. CHRISTINE MARIE ZGORKA M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WX0106X	Occupational Health Registered Nurse	28071763A	IN
2	364SA2200X	Adult Health Clinical Nurse Specialist	70000148A	IN

General Provider Information

NPI Number	:	1154574473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE MARIE ZGORKA M.S.

Provider Business Mailing Address
First Line	:	9813 CRIMSON TREE LN
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-4112
Country	:	US
Telephone Number	:	219-924-3307
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 WATLING ST # 8-210
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-1716
Country	:	US
Telephone Number	:	219-399-6067
Fax Number	:	219-399-5814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2008
Last Update Date	:	10/30/2008

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