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General NPI Number Information
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NPI Number | 1336165406
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Entity Type | Individual
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Provider Name | KATHRYN M GJELDUM ANP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 6375 US HIGHWAY 6 STE B
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City | PORTAGE
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State | IN
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Zip | 46368-5218
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Country | US
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Telephone | 219-762-0400
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Fax | 219-762-2460
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Provider Business Mailing Address
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Address Line | 10625 OLCOTT AVE
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City | SAINT JOHN
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State | IN
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Zip | 46373-8966
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Country | US
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Telephone | 219-677-9672
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71001746A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 71001746A
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License Number State | IN
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