Individual
KATHRYN M GJELDUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-BC
Contact information
Practice address
6375 US HIGHWAY 6 STE B, PORTAGE, IN 46368-5218
(219) 762-0400
(219) 762-2460
Mailing address
10625 OLCOTT AVE, SAINT JOHN, IN 46373-8966
(219) 677-9672
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71001746A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71001746A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000594185
ANTHEM BC/BS
IN
05
—
200805880
—
IN
Enumeration date
07/14/2006
Last updated
11/06/2025
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