Individual
KYLE D. KIESEWETTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
221 NE GLEN OAK AVE, PEORIA, IL 61636-0001
(309) 672-4859
Mailing address
1210 N OLD TRAIL RD, EAST PEORIA, IL 61611-1212
(309) 264-1234
Taxonomy
Speciality
Code
Description
License number
State
364SG0600X
Gerontology Clinical Nurse Specialist
Primary
209.020932
IL
Other
Enumeration date
02/27/2020
Last updated
02/27/2020
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