Provider Demographics
NPI:1760372171
Name:KISTENMACHER, ANYA
Entity type:Individual
Prefix:
First Name:ANYA
Middle Name:
Last Name:KISTENMACHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 N ALTONA ST
Mailing Address - Street 2:
Mailing Address - City:HOLSTEIN
Mailing Address - State:IA
Mailing Address - Zip Code:51025-7729
Mailing Address - Country:US
Mailing Address - Phone:712-369-3631
Mailing Address - Fax:
Practice Address - Street 1:108 N ALTONA ST
Practice Address - Street 2:
Practice Address - City:HOLSTEIN
Practice Address - State:IA
Practice Address - Zip Code:51025-7729
Practice Address - Country:US
Practice Address - Phone:712-369-3631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer