Healthcare Provider Details

I. General information

NPI: 1124802384
Provider Name (Legal Business Name): BRENNA MARIE RISSER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W WOOSTER ST
BOWLING GREEN OH
43402-2699
US

IV. Provider business mailing address

77 BACK BAY RD
BOWLING GREEN OH
43402-9742
US

V. Phone/Fax

Practice location:
  • Phone: 419-354-8000
  • Fax:
Mailing address:
  • Phone: 201-655-9183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: