MEDICARE: TRACI RIZZO MSN, PMHNP-BC

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	163W00000X	Registered Nurse	4704256399	MI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2025029451	MI

General Provider Information

NPI Number	:	1972144855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACI RIZZO MSN, PMHNP-BC

Provider Business Mailing Address
First Line	:	22198 28 MILE RD
Second Line	:
City	:	RAY
State	:	MI
Zip	:	48096-3227
Country	:	US
Telephone Number	:	586-822-1932
Fax Number	:

Provider Business Practice Location Address
First Line	:	39600 GARFIELD RD STE F
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-5913
Country	:	US
Telephone Number	:	734-600-7873
Fax Number	:

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

Provider Enumeration Date	:	10/02/2019
Last Update Date	:	06/09/2025

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