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Individual

ISABELLA MARY KISTNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
945 N 12TH ST, MILWAUKEE, WI 53233-1305
(414) 219-2000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7489
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100243933
WI
05
1447952478
WI
Enumeration date
03/21/2023
Last updated
10/17/2023
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