Provider Demographics
NPI:1154847317
Name:KISTNER, ANDREA (NP-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:KISTNER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:ANSTED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:827 REGINA PKWY
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-3331
Mailing Address - Country:US
Mailing Address - Phone:419-308-0071
Mailing Address - Fax:
Practice Address - Street 1:2600 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3207
Practice Address - Country:US
Practice Address - Phone:419-696-7493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-19
Last Update Date:2017-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily