Healthcare Provider Details

I. General information

NPI: 1932623469
Provider Name (Legal Business Name): JOHN RISI FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2266 S DOBSON RD STE 200
MESA AZ
85202
US

IV. Provider business mailing address

2266 S DOBSON RD STE 200
MESA AZ
85202-6412
US

V. Phone/Fax

Practice location:
  • Phone: 480-568-2802
  • Fax: 866-226-5767
Mailing address:
  • Phone: 480-568-2802
  • Fax: 866-226-5767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10396
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP10396
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: