MEDICARE: DANIELLE KISTLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC1500X	Community Health Registered Nurse	679825	PA

General Provider Information

NPI Number	:	1922670959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE KISTLER

Provider Business Mailing Address
First Line	:	6521 GRANVILLE RD
Second Line	:
City	:	ZIONSVILLE
State	:	PA
Zip	:	18092-2164
Country	:	US
Telephone Number	:	215-804-6105
Fax Number	:

Provider Business Practice Location Address
First Line	:	6521 GRANVILLE RD
Second Line	:
City	:	ZIONSVILLE
State	:	PA
Zip	:	18092-2164
Country	:	US
Telephone Number	:	215-804-6105
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	07/09/2021

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Directions to “ DANIELLE KISTLER ” Practice Location

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