Provider Demographics
NPI:1104247683
Name:KISNER, CHRISTIANNE C (NP)
Entity type:Individual
Prefix:
First Name:CHRISTIANNE
Middle Name:C
Last Name:KISNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHRISTIANNE
Other - Middle Name:C
Other - Last Name:DELAMERCED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2841 LOMITA BLVD.
Mailing Address - Street 2:SUITE 220
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-326-8600
Mailing Address - Fax:310-326-8366
Practice Address - Street 1:2841 LOMITA BLVD.
Practice Address - Street 2:SUITE 220
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-326-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-30
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23636363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner