Provider Demographics
NPI:1245651249
Name:GEORGIOU, KATHLEEN MARIA (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIA
Last Name:GEORGIOU
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:LAKE CENTRAL SCHOOL CORPORATION
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373
Mailing Address - Country:US
Mailing Address - Phone:219-365-8507
Mailing Address - Fax:
Practice Address - Street 1:225 W 77TH AVE.
Practice Address - Street 2:GRIMMER MIDDLE SCHOOL
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375
Practice Address - Country:US
Practice Address - Phone:219-865-6985
Practice Address - Fax:219-865-4423
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28130977A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse