Individual
MR. JUSTIN WILLIAM KIERBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACNP-BC
Contact information
Practice address
1800 E LAKE SHORE DR, DECATUR, IL 62521-3810
(217) 422-6100
Mailing address
1750 E LAKE SHORE DR, SUITE 200, DECATUR, IL 62521-3803
(217) 428-6300
(217) 428-6322
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
209.008969
IL
363LA2100X
Acute Care Nurse Practitioner
Primary
209008969
IL
Other
Enumeration date
08/05/2011
Last updated
12/23/2021
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