MEDICARE: ANNE-MARIE RIZKALLA CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	25ME00035701	NJ
2	176B00000X	Midwife	25ME00035701	NJ
3	176B00000X	Midwife	F000925-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053372722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE-MARIE RIZKALLA CNM

Provider Business Mailing Address
First Line	:	27 MOUNTAIN BLVD
Second Line	:	SUITE 6
City	:	WARREN
State	:	NJ
Zip	:	07059-5605
Country	:	US
Telephone Number	:	908-561-1102
Fax Number	:	908-561-1106

Provider Business Practice Location Address
First Line	:	27 MOUNTAIN BLVD
Second Line	:	SUITE 6
City	:	WARREN
State	:	NJ
Zip	:	07059-5605
Country	:	US
Telephone Number	:	908-561-1102
Fax Number	:	908-561-1106

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	02/28/2017

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