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General NPI Number Information
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NPI Number | 1346322559
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Entity Type | Individual
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Provider Name | MARY RISVOLD M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 2200 S HOUGHTON RD
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City | TUCSON
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State | AZ
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Zip | 85748-7632
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Country | US
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Telephone | 520-543-6100
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Fax | 659-235-6176
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Provider Business Mailing Address
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Address Line | 1000 N OAK AVE
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City | MARSHFIELD
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State | WI
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Zip | 54449-5703
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Country | US
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Telephone | 715-387-5511
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 37737
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 5124
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 84146
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License Number State | WI
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