Provider Demographics
NPI:1447544168
Name:KINDLER, NICOLE L (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:KINDLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:MARASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:815 SIR THOMAS CT STE 200
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4839
Mailing Address - Country:US
Mailing Address - Phone:717-724-0720
Mailing Address - Fax:717-724-0730
Practice Address - Street 1:815 SIR THOMAS CT STE 200
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4839
Practice Address - Country:US
Practice Address - Phone:717-724-0720
Practice Address - Fax:717-724-0730
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054966363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA221948Medicare PIN