Healthcare Provider Details

I. General information

NPI: 1619495009
Provider Name (Legal Business Name): ALICIA KISTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3365 HIGH POINT BLVD
BETHLEHEM PA
18017-7806
US

IV. Provider business mailing address

2283 BRIARWOOD DR
COPLAY PA
18037-2261
US

V. Phone/Fax

Practice location:
  • Phone: 610-954-5433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN550839
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: