Basic Information
| Provider Information | |||||||||
| NPI: | 1043876345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RISSMILLER | ||||||||
| FirstName: | DELIA | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 264 HARVARD ST APT 6 | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021392522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173088181 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 398 NEPONSET AVE | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021223134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172823200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2019 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN2321723 | MA | N | Nursing Service Providers | Registered Nurse | 363LC1500X | RN2321723 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Community Health |
No ID Information.