Provider Demographics
NPI:1487252490
Name:RIESEN, ANGELA LANAE (FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LANAE
Last Name:RIESEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:L
Other - Last Name:SPENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:617 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-1564
Mailing Address - Country:US
Mailing Address - Phone:785-632-2144
Mailing Address - Fax:
Practice Address - Street 1:617 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-1564
Practice Address - Country:US
Practice Address - Phone:785-632-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS79725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily