Provider Demographics
NPI:1518737816
Name:KISCIRAS, ILENA SOPHIA (NP)
Entity Type:Individual
Prefix:
First Name:ILENA
Middle Name:SOPHIA
Last Name:KISCIRAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LENA
Other - Middle Name:SOPHIA
Other - Last Name:KISCIRAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:100 BRIDLE TRL
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-1404
Mailing Address - Country:US
Mailing Address - Phone:203-837-6878
Mailing Address - Fax:
Practice Address - Street 1:761 MAIN AVE BLDG A
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1080
Practice Address - Country:US
Practice Address - Phone:203-810-4151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT21332340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily