Healthcare Provider Details

I. General information

NPI: 1376465385
Provider Name (Legal Business Name): CHRISTINE A TRKSAK GIBERTINI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTIE GIBERTINI

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 N STATE ROAD 39 STE 5
LA PORTE IN
46350-2089
US

IV. Provider business mailing address

2626 N STATE ROAD 39 STE 5
LA PORTE IN
46350-2089
US

V. Phone/Fax

Practice location:
  • Phone: 219-402-0535
  • Fax:
Mailing address:
  • Phone: 815-531-9671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: