Healthcare Provider Details

I. General information

NPI: 1992108450
Provider Name (Legal Business Name): AUTUMN RISNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 TILE MILL RD
BEAVER OH
45613-9435
US

IV. Provider business mailing address

2931 SALEM RD
MINFORD OH
45653-8706
US

V. Phone/Fax

Practice location:
  • Phone: 740-226-6402
  • Fax: 740-226-6122
Mailing address:
  • Phone: 740-820-2948
  • Fax: 740-226-6122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-281975
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: