Individual
KIERSTEN NICOLE BASCIANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1051 JOHNSTON WILLIS DR STE 200, NORTH CHESTERFIELD, VA 23235-4871
(804) 320-2705
(804) 330-2433
Mailing address
PO BOX 402924, ATLANTA, GA 30384-2924
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110007461
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/05/2019
Last updated
10/06/2020
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