Individual
MR. KEVIN KISSANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ACNP-BC
Contact information
Practice address
1653 W CONGRESS PKWY, CHICAGO, IL 60612-3833
(312) 942-5878
(312) 942-8021
Mailing address
3654 S UNION AVE, CHICAGO, IL 60609-1647
(630) 207-5386
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
209-002655
IL
Other
Enumeration date
03/03/2016
Last updated
03/03/2016
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