Provider Demographics
NPI:1073850376
Name:RIESS, VERONICA MAE (NP)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:MAE
Last Name:RIESS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 E MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9510
Mailing Address - Country:US
Mailing Address - Phone:989-980-2448
Mailing Address - Fax:
Practice Address - Street 1:2935 HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-8931
Practice Address - Country:US
Practice Address - Phone:989-773-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704264499363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care