Healthcare Provider Details

I. General information

NPI: 1003362682
Provider Name (Legal Business Name): MICHELLE RISING NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 MAIN ST
CANDOR NY
13743-1617
US

IV. Provider business mailing address

33 LEWIS RD 2ND FLOOR
BINGHAMTON NY
13905-1048
US

V. Phone/Fax

Practice location:
  • Phone: 607-659-7272
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340954
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: