Provider Demographics
NPI:1447013123
Name:KUETEMAN, KRISTI NICOLE
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:NICOLE
Last Name:KUETEMAN
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 1:3536 E 28TH RD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:IL
Mailing Address - Zip Code:61360-9516
Mailing Address - Country:US
Mailing Address - Phone:779-237-6212
Mailing Address - Fax:
Practice Address - Street 1:1168 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1589
Practice Address - Country:US
Practice Address - Phone:815-690-5337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043121244163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse