Healthcare Provider Details

I. General information

NPI: 1871583385
Provider Name (Legal Business Name): THERESA MARIE RISPOLI BSN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19490 SANDRIDGE WAY STE 350
LEESBURG VA
20176-3467
US

IV. Provider business mailing address

19490 SANDRIDGE WAY STE 350
LEESBURG VA
20176-3467
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-5599
  • Fax: 703-858-5699
Mailing address:
  • Phone: 703-858-5599
  • Fax: 703-858-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024162588
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP7899
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: