Healthcare Provider Details

I. General information

NPI: 1770683864
Provider Name (Legal Business Name): RAYMOND MARION RISHEL R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 SHORES ST NE
SALEM OR
97301-3090
US

IV. Provider business mailing address

883 SHORES ST NE
SALEM OR
97301-3090
US

V. Phone/Fax

Practice location:
  • Phone: 503-315-9862
  • Fax: 503-315-9862
Mailing address:
  • Phone: 503-315-9862
  • Fax: 503-315-9862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: