Provider Demographics
NPI:1417258930
Name:RISA, DEBORAH W (NP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:W
Last Name:RISA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 S BERKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6815
Mailing Address - Country:US
Mailing Address - Phone:574-534-9911
Mailing Address - Fax:574-534-6915
Practice Address - Street 1:2417 S BERKSHIRE RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6815
Practice Address - Country:US
Practice Address - Phone:574-534-9911
Practice Address - Fax:574-534-6915
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003441A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily