Provider Demographics
NPI:1073513065
Name:RIZOR, HELENA M B (PA)
Entity Type:Individual
Prefix:MRS
First Name:HELENA
Middle Name:M B
Last Name:RIZOR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 E CENTER ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4105
Mailing Address - Country:US
Mailing Address - Phone:208-234-1300
Mailing Address - Fax:208-234-1333
Practice Address - Street 1:1448 E CENTER ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4105
Practice Address - Country:US
Practice Address - Phone:208-234-1300
Practice Address - Fax:208-234-1333
Is Sole Proprietor?:No
Enumeration Date:2005-07-30
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA517363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1801989454Medicaid
ID1801989454Medicaid
IDPASE8OtherBLUECROSS OF IDAHO
ID32035OtherDMBA
ID000010148545OtherBLUESHIELD OF IDAHO
IDDO5955OtherRAILROAD MEDICARE
ID113798100OtherWYOMING CONSULTEC EDS
ID16662986Medicare PIN
IDQ30069Medicare UPIN