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General NPI Number Information
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NPI Number | 1790464535
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Entity Type | Individual
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Provider Name | KRISTIN SEWNIG FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 2701 OCEAN PARK BLVD STE 114
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City | SANTA MONICA
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State | CA
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Zip | 90405-5200
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Country | US
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Telephone | 310-452-3206
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Fax |
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Provider Business Mailing Address
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Address Line | 3730 W 107TH ST
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City | CHICAGO
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State | IL
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Zip | 60655-3801
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Country | US
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Telephone | 708-829-8789
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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 | 041317588
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License Number State | IL
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