Healthcare Provider Details

I. General information

NPI: 1265499271
Provider Name (Legal Business Name): RISE CAROL HATTEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RISE CAROL CIEGLER

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N EAST ST
OLNEY IL
62450-6927
US

IV. Provider business mailing address

1120 N EAST ST
OLNEY IL
62450-6927
US

V. Phone/Fax

Practice location:
  • Phone: 618-395-5222
  • Fax: 618-395-8552
Mailing address:
  • Phone: 618-395-5222
  • Fax: 618-395-8552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036.119656
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: