Provider Demographics
NPI:1376819516
Name:KISER, SARAH REBECCA (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:REBECCA
Last Name:KISER
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7002
Mailing Address - Country:US
Mailing Address - Phone:781-489-1937
Mailing Address - Fax:781-235-0308
Practice Address - Street 1:142 GROVE ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7002
Practice Address - Country:US
Practice Address - Phone:781-489-1937
Practice Address - Fax:781-235-0308
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN270702363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics