Kiesewetter, Mary K

Kiesewetter, Mary K is an individual health care provider with primary practice located at 1802 S Mattis Ave , Champaign IL 61821-5923. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Kiesewetter, Mary K can be contacted via phone (217) 365-2855.

Contact Information

Primary practice address
1802 S Mattis Ave Champaign IL 61821-5923
Phone: (217) 365-2855
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 209020494 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 209.020494 Illinois

Profile Details

NPI number 1114563640
LBN Legal business name Kiesewetter, Mary K
Credentials PMHNP
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 19th, 2019
Last updated Nov 21st, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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