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General NPI Number Information
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NPI Number | 1811552896
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Entity Type | Individual
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Provider Name | KRISTINE NISSLEY CRNP
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Gender | Female
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | EINSTEIN UROLOGY ASSOCIATES 1200 WEST TABOR ROAD, 3RD FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19141
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Country | US
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Telephone | 215-456-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 1031 SURREY RD
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City | PHILADELPHIA
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State | PA
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Zip | 19115-4525
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Country | US
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Telephone | 215-989-8440
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN645735
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP019518
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License Number State | PA
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