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General NPI Number Information
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NPI Number | 1669063566
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Entity Type | Individual
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Provider Name | KATHLEEN MICHELE KIZZEE AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/02/2021
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 1340 S DAMEN AVE STE 200
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City | CHICAGO
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State | IL
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Zip | 60608-1170
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Country | US
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Telephone | 312-997-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 2080 HASSELL RD APT 304
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-6334
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Country | US
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Telephone | 224-279-3229
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209022489
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License Number State | IL
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