Provider Demographics
NPI:1972144855
Name:RIZZO, TRACI (MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:RIZZO
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22198 28 MILE RD
Mailing Address - Street 2:
Mailing Address - City:RAY
Mailing Address - State:MI
Mailing Address - Zip Code:48096-3227
Mailing Address - Country:US
Mailing Address - Phone:586-822-1932
Mailing Address - Fax:
Practice Address - Street 1:39600 GARFIELD RD STE F
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-5913
Practice Address - Country:US
Practice Address - Phone:734-600-7873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704256399163W00000X
MI2025029451363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse