Provider Demographics
NPI:1306904990
Name:DENENBERG, RISA (ARNP)
Entity type:Individual
Prefix:
First Name:RISA
Middle Name:
Last Name:DENENBERG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98886
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98496-8886
Mailing Address - Country:US
Mailing Address - Phone:253-581-3075
Mailing Address - Fax:253-581-3178
Practice Address - Street 1:4905 108TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3724
Practice Address - Country:US
Practice Address - Phone:253-581-3075
Practice Address - Fax:253-581-3178
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60029600163W00000X
WAAP60030791363LF0000X
PASPOO8438363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1306904990Medicaid
109409RP5Medicare PIN
G8902875Medicare PIN
WA1306904990Medicaid