Individual
CAROLYN ROSE KISTINGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
551 SMITHTOWN AVE, BOHEMIA, NY 11716-4915
(631) 432-5219
Mailing address
551 SMITHTOWN AVE, BOHEMIA, NY 11716-4915
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
325760
NY
Other
Enumeration date
09/18/2018
Last updated
09/18/2018
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