Provider Demographics
NPI:1598953424
Name:IOVANELLA, KRISTEN BLAIR (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:BLAIR
Last Name:IOVANELLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MAIN ST
Mailing Address - Street 2:2
Mailing Address - City:TOPSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01983-1805
Mailing Address - Country:US
Mailing Address - Phone:413-537-2377
Mailing Address - Fax:
Practice Address - Street 1:694 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-2229
Practice Address - Country:US
Practice Address - Phone:781-595-7348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA2414363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant