Provider Demographics
NPI:1962591339
Name:RISTANEO, CONNIE R (RN)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:R
Last Name:RISTANEO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:R
Other - Last Name:RISTANEO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:4100 W 3RD ST
Mailing Address - Street 2:PRIME CARE
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45428-9000
Mailing Address - Country:US
Mailing Address - Phone:937-268-6511
Mailing Address - Fax:937-267-5316
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:PRIME CARE
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:937-267-5316
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN211242163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse