Provider Demographics
NPI:1922670959
Name:KISTLER, DANIELLE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:KISTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6521 GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18092-2164
Mailing Address - Country:US
Mailing Address - Phone:215-804-6105
Mailing Address - Fax:
Practice Address - Street 1:6521 GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18092-2164
Practice Address - Country:US
Practice Address - Phone:215-804-6105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA679825163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health