Healthcare Provider Details

I. General information

NPI: 1104104892
Provider Name (Legal Business Name): CARISSA JO RANIERI APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARISSA JO MEYER APNP

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 W AMERICAN DR
NEENAH WI
54956-1405
US

IV. Provider business mailing address

2223 LIME KILN RD STE 1
GREEN BAY WI
54311-6238
US

V. Phone/Fax

Practice location:
  • Phone: 920-430-8113
  • Fax:
Mailing address:
  • Phone: 920-430-8113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4468-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: