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General NPI Number Information
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NPI Number | 1578339065
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Entity Type | Individual
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Provider Name | GIA CHEZVON SHORT PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 100 W CHICAGO AVE STE F
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City | EAST CHICAGO
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State | IN
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Zip | 46312-3261
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Country | US
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Telephone | 219-392-7016
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Fax | 219-397-6904
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Provider Business Mailing Address
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Address Line | 8558 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7032
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Country | US
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Telephone | 219-392-7084
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Fax | 219-703-6854
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71015877A
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License Number State | IN
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