Individual
MS. JACQUELYN GABRIELLE KISTENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RNFA
Contact information
Practice address
4052 COMMODORE DR, CHAMBLEE, GA 30341-1556
(678) 444-4175
(404) 601-8404
Mailing address
5456 PEACHTREE BLVD # 262, ATLANTA, GA 30341-2235
(404) 636-0096
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
195446
GA
Other
Enumeration date
06/09/2014
Last updated
11/29/2017
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