MEDICARE: AVERY RISHER

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1376010033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVERY RISHER

Provider Business Mailing Address
First Line	:	3900 E SUNSET RD APT 2016
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3987
Country	:	US
Telephone Number	:	702-479-9382
Fax Number	:

Provider Business Practice Location Address
First Line	:	6941 SILVER BANGLE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-8305
Country	:	US
Telephone Number	:	702-479-8392
Fax Number	:

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

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	10/30/2018

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Directions to “ AVERY RISHER ” Practice Location

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