Provider Demographics
NPI:1992108450
Name:RISNER, AUTUMN (RN)
Entity type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:
Last Name:RISNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:MINFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45653-8706
Mailing Address - Country:US
Mailing Address - Phone:740-820-2948
Mailing Address - Fax:740-226-6122
Practice Address - Street 1:1170 TILE MILL RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:OH
Practice Address - Zip Code:45613-9435
Practice Address - Country:US
Practice Address - Phone:740-226-6402
Practice Address - Fax:740-226-6122
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-281975163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool