Individual
JESSICA KISZKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
9104 COLUMBIA AVE, MUNSTER, IN 46321-2907
(219) 836-4473
Mailing address
9104 COLUMBIA AVE, MUNSTER, IN 46321-2907
(219) 306-6602
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209011602
IL
363LG0600X
Gerontology Nurse Practitioner
Primary
71005664A
IN
Other
Enumeration date
06/24/2014
Last updated
10/08/2020
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