MARY KIESEWETTER, PMHNP

Nurse Practitioner

Active Individual
NPI: 1114563640

Practice Address

1802 S MATTIS AVE
Champaign, IL 61821

Phone: (217) 365-2855

Specialties

Specialty Code Primary License
Nurse Practitioner 363L00000X Yes 209020494 (IL)
Nurse Practitioner - Psychiatric/Mental Health 363LP0808X No 209.020494 (IL)

Frequently Asked Questions

NPI 1114563640 is the National Provider Identifier for MARY KIESEWETTER, PMHNP, a Nurse Practitioner provider located in Champaign, IL. This NPI was enumerated on November 19, 2019.
MARY KIESEWETTER, PMHNP practices at 1802 S MATTIS AVE, Champaign, IL 61821.

Quick Facts

NPI
1114563640
Type
Individual
Enumerated
Nov 19, 2019
Last Updated
Nov 21, 2019

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