Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 038010007 | IL |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 038010007 | IL |
N | 363LA2200X | Nurse Practitioner - Adult Health | 209009686 | IL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209009686 | IL |
N | 363LG0600X | Nurse Practitioner - Gerontology | 209009686 | IL |
N | 363LP2300X | Nurse Practitioner - Primary Care | 209009686 | IL |
NPI | 1679654974 |
---|---|
Provider Name | Dr. Paul David Rieselman |
First Address | Lisle, IL 60532-1289 |
Second Address | Lisle, IL 60532-1289 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 17/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U97446 | (02) | IL |