Provider Demographics
NPI:1942035647
Name:RISSMAN, JENNIFER
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:RISSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 E COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3561
Mailing Address - Country:US
Mailing Address - Phone:570-239-6768
Mailing Address - Fax:
Practice Address - Street 1:10153 E HAMPTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3326
Practice Address - Country:US
Practice Address - Phone:480-535-5688
Practice Address - Fax:888-866-6737
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath