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General NPI Number Information
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NPI Number | 1629908553
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Entity Type | Individual
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Provider Name | MATTHEW NISTOR
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Gender | Male
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Dates
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Enumeration Date | 05/21/2026
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Last Update Date | 05/21/2026
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Provider Practice Location Address
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Address Line | 1 HACC DR
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City | HARRISBURG
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State | PA
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Zip | 17110-2903
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Country | US
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Telephone | 347-352-1766
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 205
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City | LEOLA
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State | PA
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Zip | 17540-0205
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Country | US
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Telephone | 347-352-1766
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146L00000X
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Taxonomy Name | Paramedic
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License Number | 204689
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License Number State | PA
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