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General NPI Number Information
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NPI Number | 1154621571
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Entity Type | Individual
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Provider Name | LISA RAE RISOVI LMT
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Gender | Female
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 7 3RD ST SE STE 204
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City | MINOT
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State | ND
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Zip | 58701-3916
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Country | US
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Telephone | 701-721-0738
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Fax |
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Provider Business Mailing Address
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Address Line | 7 3RD ST SE STE 204
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City | MINOT
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State | ND
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Zip | 58701-3916
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Country | US
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Telephone | 701-839-8964
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 468
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | H-0305
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License Number State | ND
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