Provider Demographics
NPI:1063710861
Name:RISNER-NEFF, MICSHELL NICOLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:MICSHELL
Middle Name:NICOLE
Last Name:RISNER-NEFF
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177A BLOOM FURNACE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEBSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45682-8938
Mailing Address - Country:US
Mailing Address - Phone:174-077-8294
Mailing Address - Fax:
Practice Address - Street 1:177A BLOOM FURNACE LN
Practice Address - Street 2:
Practice Address - City:SOUTH WEBSTER
Practice Address - State:OH
Practice Address - Zip Code:45682-8938
Practice Address - Country:US
Practice Address - Phone:174-077-8294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.132498164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse