Provider Demographics
NPI:1184075194
Name:PISANO, KRISTIN (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:PISANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:N
Other - Last Name:PISANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:1 S END BRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-2020
Mailing Address - Country:US
Mailing Address - Phone:413-374-0031
Mailing Address - Fax:
Practice Address - Street 1:1 S END BRIDGE CIR
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-2020
Practice Address - Country:US
Practice Address - Phone:413-374-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5587363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant