Individual
CARMELLA KIMBERLY KISTNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
90 DOG WOOD LN, WADING RIVER, NY 11792-1803
(631) 356-9739
Mailing address
90 DOG WOOD LN, WADING RIVER, NY 11792-1803
(631) 356-9739
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
660370
NY
Other
Enumeration date
09/06/2012
Last updated
04/07/2015
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