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General NPI Number Information
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NPI Number | 1558166751
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Entity Type | Individual
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Provider Name | MARY JEAN KLEINAITIS NP
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Gender | Female
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 6916 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402-2244
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Country | US
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Telephone | 708-933-3840
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 GREENLEAF AVE APT 201
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City | WILMETTE
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State | IL
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Zip | 60091-2757
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Country | US
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Telephone | 765-426-4931
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209029117
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License Number State | IL
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