Provider Demographics
NPI:1194763656
Name:RISING, SUE ELLEN
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:ELLEN
Last Name:RISING
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 1:2204 GREENSBURG RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-1197
Mailing Address - Country:US
Mailing Address - Phone:330-899-0024
Mailing Address - Fax:
Practice Address - Street 1:2204 GREENSBURG RD
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1197
Practice Address - Country:US
Practice Address - Phone:330-899-0024
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2268166Medicaid