Provider Demographics
NPI:1659326072
Name:KISNER, BETTE (APRN-BC,MSN)
Entity type:Individual
Prefix:
First Name:BETTE
Middle Name:
Last Name:KISNER
Suffix:
Gender:F
Credentials:APRN-BC,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 TURNPIKE STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3904
Mailing Address - Country:US
Mailing Address - Phone:617-840-3250
Mailing Address - Fax:617-739-6225
Practice Address - Street 1:275 TURNPIKE ST STE 105
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2353
Practice Address - Country:US
Practice Address - Phone:781-828-6633
Practice Address - Fax:781-821-1743
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA98955163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN0250OtherBLUE CROSS
MAS76433Medicare UPIN
MAPN0250OtherBLUE CROSS
MAPN0250OtherBLUE CROSS