MARY KIESEWETTER, PMHNP
Nurse Practitioner
Active
Individual
NPI: 1114563640
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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