Provider Demographics
NPI:1356068118
Name:KIELB, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:KIELB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1743 N LEAVITT ST APT 205
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5462
Mailing Address - Country:US
Mailing Address - Phone:630-632-0812
Mailing Address - Fax:
Practice Address - Street 1:1743 N LEAVITT ST APT 205
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5462
Practice Address - Country:US
Practice Address - Phone:630-632-0812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILF09220295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily