Provider Demographics
NPI:1093495517
Name:DE ANGELO, RISSA ELLE (RN)
Entity Type:Individual
Prefix:
First Name:RISSA
Middle Name:ELLE
Last Name:DE ANGELO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RISSA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:270 NE SANTA MARIA LN
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-9259
Mailing Address - Country:US
Mailing Address - Phone:405-623-6398
Mailing Address - Fax:
Practice Address - Street 1:270 NE SANTA MARIA LN
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-9259
Practice Address - Country:US
Practice Address - Phone:405-623-6398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60460408163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse