Doctor Name: | MS. COLLETTE ANN KLEIN |
NPI Number: | 1659639862 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN MSN FPMHNP-BC |
License Number: | 209.009393 |
Business Practice Address: | 2960 Chartres St La Salle, IL - 613011097 |
Business Phone Number: | 8152241610 |
Business Fax Number: | 8152231634 |
Mailing Address: | 2003 6th St, PERU |
State: | IL |
Postal Code: | 613542512 |
Phone Number: | 8152241610 |
Fax Number: | 8152231634 |
NPI Enumeration Date: | 04/25/2012 |
NPI Last Update Date: | 04/25/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0808X |
License Number: | 209.009393 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |