Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209.024000 | IL |
N | 363L00000X | Nurse Practitioner | 9220 | WI |
N | 363L00000X | Nurse Practitioner | 9220-33 | WI |
NPI | 1003461336 |
---|---|
Provider Name | Vanja Z Rissky |
First Address | Chicago, IL 60674 |
Second Address | Zion, IL 60099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2019 |
Last Update Date | 03/12/2021 |