Healthcare Provider Details

I. General information

NPI: 1306932850
Provider Name (Legal Business Name): SUZANNE YVETTE RISMA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FITNESS & HEALTH CENTER 17890 E. STEAMBOAT AVE BLDG #35
BUCKLEY AFB CO
80011-9547
US

IV. Provider business mailing address

2540 W 109TH AVE
WESTMINSTER CO
80234-3130
US

V. Phone/Fax

Practice location:
  • Phone: 720-847-5699
  • Fax: 720-847-6436
Mailing address:
  • Phone: 303-465-0158
  • Fax: 303-465-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: