MEDICARE: JOAN L RISHEL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	0606	MA
2	363A00000X	Physician Assistant	000552	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000552	OTHER	CT	STATE PA LICENSE NUMBER

General Provider Information

NPI Number	:	1194823575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN L RISHEL PA-C

Provider Business Mailing Address
First Line	:	30 JORDAN LN
Second Line	:
City	:	WETHERSFIELD
State	:	CT
Zip	:	06109-1278
Country	:	US
Telephone Number	:	860-263-0253
Fax Number	:	860-263-0262

Provider Business Practice Location Address
First Line	:	342 N MAIN ST STE 350
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06117-2500
Country	:	US
Telephone Number	:	860-296-4022
Fax Number	:	860-772-0095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	01/19/2023

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Directions to “ JOAN L RISHEL PA-C” Practice Location

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