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General NPI Number Information
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NPI Number | 1497907513
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Entity Type | Individual
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Provider Name | JULIE ANN RISSE RDH
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Gender | Female
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 925 S 15TH ST
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City | MANITOWOC
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State | WI
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Zip | 54220-5051
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Country | US
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Telephone | 920-652-0238
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Fax |
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Provider Business Mailing Address
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Address Line | 6120 SELLE RD
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City | MANITOWOC
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State | WI
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Zip | 54220-9537
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Country | US
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Telephone | 920-758-3086
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 5727-016
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License Number State | WI
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