Individual
PROF. KYLEA LIESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD CNM
Contact information
Practice address
2233 W DIVISION ST, CHICAGO, IL 60622
(312) 770-2336
Mailing address
2233 W DIVISION ST, CHICAGO, IL 60622-8151
(312) 770-2336
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
—
—
Other
Enumeration date
05/18/2012
Last updated
06/24/2019
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