Provider Demographics
NPI:1255302030
Name:KLEISTER, DENISE P (NP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:P
Last Name:KLEISTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NEPONSET ST FL STREET2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-368-5532
Mailing Address - Fax:508-368-3113
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 150 S
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-368-3110
Practice Address - Fax:508-368-3113
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA137040363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0328791Medicaid
53325OtherFALLON COMMUNITY HEALTH P
8301688OtherEVERCARE
0328791OtherMEDICAID WELFARE
NP9708OtherBLUE CARE ELECT
NP9708OtherMEDICARE B
NP9708OtherBLUE SHIELD HMO BLUE
NP9708OtherBLUE SHIELD INDEMNITY
58263OtherCHILDRENS MEDICAL SECURIT
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTHREE RIVERS
58263OtherHEALTHY START
AA3630OtherHARVARD PILGRIM HEALTHCAR
042472266OtherPRIVATE HEALTHCARE SYSTEM
NP9708OtherBLUE SHIELD HMO BLUE