Provider Demographics
NPI:1699814715
Name:XISTRIS, DEANNA G (APRN)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:G
Last Name:XISTRIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL PLZ
Mailing Address - Street 2:BENNETT CANCER CENTER
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06904-9317
Mailing Address - Country:US
Mailing Address - Phone:203-276-2695
Mailing Address - Fax:203-975-7842
Practice Address - Street 1:1 HOSPITAL PLZ
Practice Address - Street 2:BENNETT CANCER CENTER
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06904-9317
Practice Address - Country:US
Practice Address - Phone:203-276-2695
Practice Address - Fax:203-975-7842
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002056363L00000X
CT2056363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004000360Medicaid
S68701Medicare UPIN
890000157Medicare ID - Type Unspecified