MEDICARE: MS. MARIA DENISE RISALITI CFNP

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	363LF0000X	Family Nurse Practitioner	671906	TX

General Provider Information

NPI Number	:	1114115482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA DENISE RISALITI CFNP

Provider Business Mailing Address
First Line	:	2107 WESTOVER RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-1211
Country	:	US
Telephone Number	:	512-480-0771
Fax Number	:

Provider Business Practice Location Address
First Line	:	2107 WESTOVER RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-1211
Country	:	US
Telephone Number	:	512-480-0771
Fax Number	:

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

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	10/11/2007

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