1245651249 NPI number — MRS. KATHLEEN MARIA GEORGIOU RN

Table of content: MRS. KATHLEEN MARIA GEORGIOU RN (NPI 1245651249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245651249 NPI number — MRS. KATHLEEN MARIA GEORGIOU RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEORGIOU
Provider First Name:
KATHLEEN
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245651249
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8260 WICKER AVE.
Provider Second Line Business Mailing Address:
LAKE CENTRAL SCHOOL CORPORATION
Provider Business Mailing Address City Name:
SAINT JOHN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-365-8507
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 W 77TH AVE.
Provider Second Line Business Practice Location Address:
GRIMMER MIDDLE SCHOOL
Provider Business Practice Location Address City Name:
SCHERERVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-865-6985
Provider Business Practice Location Address Fax Number:
219-865-4423
Provider Enumeration Date:
12/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  28130977A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com