Provider Demographics
NPI:1366864399
Name:GINDL-MRZLOCK, JEANNE (RN)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:GINDL-MRZLOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 WICKER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-8876
Mailing Address - Country:US
Mailing Address - Phone:219-365-8507
Mailing Address - Fax:
Practice Address - Street 1:8915 W 93RD AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9638
Practice Address - Country:US
Practice Address - Phone:219-365-9203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28077431A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse