Individual
MRS. MARY ELLEN KISTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 MONTVALE AVE, STE 502, STONEHAM, MA 02180-3559
(781) 279-0971
(617) 573-5646
Mailing address
1 MONTVALE AVE, STE 502, STONEHAM, MA 02180-3559
(781) 279-0971
(617) 573-5646
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1545
SC
Other
Enumeration date
09/10/2010
Last updated
01/02/2014
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