Provider Demographics
NPI:1932677937
Name:KINSELLA, ERIN GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:GRACE
Last Name:KINSELLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST FL 19
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2927
Mailing Address - Country:US
Mailing Address - Phone:312-695-8900
Mailing Address - Fax:312-695-9194
Practice Address - Street 1:676 N SAINT CLAIR ST FL 19
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-695-8900
Practice Address - Fax:312-695-9194
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085006812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant