Healthcare Provider Details

I. General information

NPI: 1194908830
Provider Name (Legal Business Name): JOHANNA KATE RIZZARDINI CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAPLE ST STE 1
HOLYOKE MA
01040-5140
US

IV. Provider business mailing address

320 RIVERSIDE DRIVE
FLORENCE MA
01062
US

V. Phone/Fax

Practice location:
  • Phone: 413-420-2200
  • Fax: 413-539-9472
Mailing address:
  • Phone: 413-586-2016
  • Fax: 413-586-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number262088
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: