Provider Demographics
NPI:1609612183
Name:KIESER, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:KIESER
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 1:1267 COUNTY ROAD 350 E
Mailing Address - Street 2:
Mailing Address - City:HENRY
Mailing Address - State:IL
Mailing Address - Zip Code:61537-9460
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1267 COUNTY ROAD 350 E
Practice Address - Street 2:
Practice Address - City:HENRY
Practice Address - State:IL
Practice Address - Zip Code:61537-9460
Practice Address - Country:US
Practice Address - Phone:309-238-1271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered