Provider Demographics
NPI:1083621742
Name:NIELSEN, RISA M (MD)
Entity Type:Individual
Prefix:DR
First Name:RISA
Middle Name:M
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:KINGSHILL
Mailing Address - State:VI
Mailing Address - Zip Code:00851-1206
Mailing Address - Country:US
Mailing Address - Phone:340-778-6680
Mailing Address - Fax:340-778-8869
Practice Address - Street 1:BEESTON HILL MEDICAL CENTER
Practice Address - Street 2:SUITE 12
Practice Address - City:ST CROIX
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-778-6680
Practice Address - Fax:340-778-8869
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VI1251207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIH19606Medicare UPIN
VI22355Medicare ID - Type Unspecified