Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | RN2321723 | MA |
NPI | 1043876345 |
---|---|
Provider Name | Delia Rissmiller |
First Address | Cambridge, MA 02139-2522 |
Second Address | Dorchester, MA 02122-3134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2019 |
Last Update Date | 08/11/2021 |