Provider Demographics
NPI:1619413671
Name:LODICS, CHRISTIE LYNNE (DNP, MSN, APRN, FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:LYNNE
Last Name:LODICS
Suffix:
Gender:F
Credentials:DNP, MSN, APRN, FNP
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:MEDELLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9016 DEWBERRY CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1527
Mailing Address - Country:US
Mailing Address - Phone:317-522-8081
Mailing Address - Fax:
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-522-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006883A363LF0000X
IN28213376A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily