Provider Demographics
NPI:1578621215
Name:KINSELLA, FREDERICK WILLIAM (NP)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:WILLIAM
Last Name:KINSELLA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-1400
Mailing Address - Country:US
Mailing Address - Phone:717-337-6970
Mailing Address - Fax:717-337-6978
Practice Address - Street 1:300 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-1400
Practice Address - Country:US
Practice Address - Phone:717-337-6970
Practice Address - Fax:717-337-6978
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP001668B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily