Healthcare Provider Details

I. General information

NPI: 1073008587
Provider Name (Legal Business Name): RONALD PETER RIESSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904B LAURENS RD
GREENVILLE SC
29607-2913
US

IV. Provider business mailing address

424 S ORCHARD FARMS AVE
SIMPSONVILLE SC
29681-4864
US

V. Phone/Fax

Practice location:
  • Phone: 864-603-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: