Healthcare Provider Details

I. General information

NPI: 1669015996
Provider Name (Legal Business Name): KRISTINA PARISE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 DAVES WAY
HAMBURG PA
19526-1413
US

IV. Provider business mailing address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 610-628-7201
  • Fax: 610-268-7211
Mailing address:
  • Phone: 484-526-2894
  • Fax: 833-213-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA061107
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: