Provider Demographics
NPI:1013765056
Name:GARDIKIOTES, KONSTANTINA (NP)
Entity Type:Individual
Prefix:
First Name:KONSTANTINA
Middle Name:
Last Name:GARDIKIOTES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7232 VALE DR
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-3513
Mailing Address - Country:US
Mailing Address - Phone:773-807-8510
Mailing Address - Fax:
Practice Address - Street 1:9410 CALUMET AVE STE 101
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-0018
Practice Address - Country:US
Practice Address - Phone:773-807-8510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015221A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily