Provider Demographics
NPI:1386264893
Name:RATANPAL, KARISSA L (CNM)
Entity type:Individual
Prefix:MRS
First Name:KARISSA
Middle Name:L
Last Name:RATANPAL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5303
Mailing Address - Country:US
Mailing Address - Phone:951-532-3394
Mailing Address - Fax:
Practice Address - Street 1:2007 GRAVES MILL RD
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2656
Practice Address - Country:US
Practice Address - Phone:434-385-8948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179227367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife