Provider Demographics
NPI:1538250543
Name:KISTNER, SUSAN THERESA (RN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:THERESA
Last Name:KISTNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 BULLS HEAD ROAD
Mailing Address - Street 2:
Mailing Address - City:CLINTON CORNERS
Mailing Address - State:NY
Mailing Address - Zip Code:12514
Mailing Address - Country:US
Mailing Address - Phone:845-266-4167
Mailing Address - Fax:
Practice Address - Street 1:41 SPRINGWOOD DRIVE
Practice Address - Street 2:DAYTOP VILLAGE ROBERT HOOK ROAD
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572
Practice Address - Country:US
Practice Address - Phone:845-876-5612
Practice Address - Fax:845-876-1334
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2524111163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse