Healthcare Provider Details

I. General information

NPI: 1871822585
Provider Name (Legal Business Name): LOU W RIESCH CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 N MO PAC EXPY BUILDING. 3, SUITE 200
AUSTIN TX
78731-3282
US

IV. Provider business mailing address

6500 N MO PAC EXPY BUILDING. 3, SUITE 200
AUSTIN TX
78731-3282
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-8400
  • Fax: 512-458-8593
Mailing address:
  • Phone: 512-458-8400
  • Fax: 512-458-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number733858
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: