Healthcare Provider Details

I. General information

NPI: 1871510685
Provider Name (Legal Business Name): PATRICIA M RIEDL APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 S MADISON ST
APPLETON WI
54915
US

IV. Provider business mailing address

1531 S MADISON ST
APPLETON WI
54915
US

V. Phone/Fax

Practice location:
  • Phone: 920-730-4411
  • Fax:
Mailing address:
  • Phone: 920-730-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number1939033
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number75770
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: