Basic Information
| Provider Information | |||||||||
| NPI: | 1871583385 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RISPOLI | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | BSN, CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11166 E PAMPA AVE | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852122237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037274520 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2640 W BASELINE RD STE 111 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850416492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806778282 | ||||||||
| FaxNumber: | 4805350962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 05/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 0024162588 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | AP7899 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.