Provider Demographics
NPI:1558166751
Name:KLEINAITIS, MARY JEAN (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JEAN
Last Name:KLEINAITIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 GREENLEAF AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2757
Mailing Address - Country:US
Mailing Address - Phone:765-426-4931
Mailing Address - Fax:
Practice Address - Street 1:6916 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2244
Practice Address - Country:US
Practice Address - Phone:708-933-3840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209029117363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily