Provider Demographics
NPI:1669063566
Name:KIZZEE, KATHLEEN MICHELE (AGPCNP-BC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MICHELE
Last Name:KIZZEE
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 HASSELL RD APT 304
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-6334
Mailing Address - Country:US
Mailing Address - Phone:224-279-3229
Mailing Address - Fax:
Practice Address - Street 1:1340 S DAMEN AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1170
Practice Address - Country:US
Practice Address - Phone:312-997-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022489363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner