Healthcare Provider Details

I. General information

NPI: 1154574473
Provider Name (Legal Business Name): CHRISTINE MARIE ZGORKA M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 WATLING ST # 8-210
EAST CHICAGO IN
46312-1716
US

IV. Provider business mailing address

9813 CRIMSON TREE LN
MUNSTER IN
46321-4112
US

V. Phone/Fax

Practice location:
  • Phone: 219-399-6067
  • Fax: 219-399-5814
Mailing address:
  • Phone: 219-924-3307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number28071763A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number70000148A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: