Provider Demographics
NPI:1083391528
Name:CHRISSIKOS, EMELINE VICTORIA (SM)
Entity Type:Individual
Prefix:MISS
First Name:EMELINE
Middle Name:VICTORIA
Last Name:CHRISSIKOS
Suffix:
Gender:F
Credentials:SM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 COUNTY ROAD 36
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-9404
Mailing Address - Country:US
Mailing Address - Phone:260-908-7336
Mailing Address - Fax:260-366-6742
Practice Address - Street 1:7980 W 100 S
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:IN
Practice Address - Zip Code:46571-9750
Practice Address - Country:US
Practice Address - Phone:260-704-7166
Practice Address - Fax:260-366-6742
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty