Provider Demographics
NPI:1427715762
Name:RISE AND SHINE HEALTHCARE LLC
Entity type:Organization
Organization Name:RISE AND SHINE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRESSETT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-481-4077
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:CHUNKY
Mailing Address - State:MS
Mailing Address - Zip Code:39323-0070
Mailing Address - Country:US
Mailing Address - Phone:601-481-4077
Mailing Address - Fax:620-647-4541
Practice Address - Street 1:9431 EASTSIDE DRIVE EXT STE B
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-8072
Practice Address - Country:US
Practice Address - Phone:601-481-4077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1689096505OtherNPI NUMBER