1306932850 NPI number — MRS. SUZANNE YVETTE RISMA RD

Table of content: MRS. SUZANNE YVETTE RISMA RD (NPI 1306932850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306932850 NPI number — MRS. SUZANNE YVETTE RISMA RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RISMA
Provider First Name:
SUZANNE
Provider Middle Name:
YVETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306932850
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2540 W 109TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80234-3130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-465-0158
Provider Business Mailing Address Fax Number:
303-465-0158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FITNESS & HEALTH CENTER
Provider Second Line Business Practice Location Address:
17890 E. STEAMBOAT AVE BLDG #35
Provider Business Practice Location Address City Name:
BUCKLEY AFB
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80011-9547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-847-5699
Provider Business Practice Location Address Fax Number:
720-847-6436
Provider Enumeration Date:
10/04/2006

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: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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