Provider Demographics
NPI:1124842992
Name:KRISTINE KITCHENER
Entity type:Organization
Organization Name:KRISTINE KITCHENER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KITCHENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-955-8813
Mailing Address - Street 1:2413 RIVER BEND LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-6695
Mailing Address - Country:US
Mailing Address - Phone:815-955-8813
Mailing Address - Fax:
Practice Address - Street 1:1000 ESSINGTON RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2841
Practice Address - Country:US
Practice Address - Phone:815-281-5955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health