Provider Demographics
NPI:1467054387
Name:RIFFEL, KAITLYN (APRN)
Entity Type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:
Last Name:RIFFEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 W MONROE ST UNIT 417
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2511
Mailing Address - Country:US
Mailing Address - Phone:330-503-0656
Mailing Address - Fax:
Practice Address - Street 1:1330 W MONROE ST UNIT 417
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2511
Practice Address - Country:US
Practice Address - Phone:330-503-0656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020113363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics