Provider Demographics
NPI:1841966272
Name:LABRIOLA, CARISSA ANN (RT(R))
Entity type:Individual
Prefix:MS
First Name:CARISSA
Middle Name:ANN
Last Name:LABRIOLA
Suffix:
Gender:F
Credentials:RT(R)
Other - Prefix:MRS
Other - First Name:CARISSA
Other - Middle Name:ANN
Other - Last Name:BYERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RT(R)
Mailing Address - Street 1:329 BELLERIVE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4166
Mailing Address - Country:US
Mailing Address - Phone:815-954-1062
Mailing Address - Fax:
Practice Address - Street 1:329 BELLERIVE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4166
Practice Address - Country:US
Practice Address - Phone:815-954-1062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL10085522085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology