Healthcare Provider Details

I. General information

NPI: 1811124936
Provider Name (Legal Business Name): DENISE KIRSTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W. CONGRESS PKWY NICU
CHICAGO IL
60612
US

IV. Provider business mailing address

3304 WREN LN
ROLLING MEADOWS IL
60008
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6640
  • Fax:
Mailing address:
  • Phone: 847-506-0326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number209.001059
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: