Healthcare Provider Details

I. General information

NPI: 1154847317
Provider Name (Legal Business Name): ANDREA KISTNER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA ANSTED

II. Dates (important events)

Enumeration Date: 08/19/2017
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6755 W CENTRAL AVE STE 101
TOLEDO OH
43617-1443
US

IV. Provider business mailing address

6755 W CENTRAL AVE STE 101
TOLEDO OH
43617-1443
US

V. Phone/Fax

Practice location:
  • Phone: 567-585-0075
  • Fax: 567-517-7105
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021562
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: