Healthcare Provider Details

I. General information

NPI: 1679016190
Provider Name (Legal Business Name): HEATHER RIESELMAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE MLC 11024
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE MLC 11024
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-803-0375
  • Fax: 513-803-1124
Mailing address:
  • Phone: 513-803-0375
  • Fax: 513-803-1124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.020145
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: