1326263294 NPI number — NADINE RISH RN

Table of content: NADINE RISH RN (NPI 1326263294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326263294 NPI number — NADINE RISH RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RISH
Provider First Name:
NADINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RISH
Provider Other First Name:
DEAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1326263294
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 PUBLIC SQ
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
WILKES BARRE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18701-1702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-823-7000
Provider Business Mailing Address Fax Number:
570-823-3040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 PUBLIC SQ
Provider Second Line Business Practice Location Address:
SUITE 312
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18701-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-826-1777
Provider Business Practice Location Address Fax Number:
570-823-3040
Provider Enumeration Date:
04/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN179770L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1015952500003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007678420038 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".