Provider Demographics
NPI:1134501497
Name:GILLASPIE, RISA
Entity Type:Individual
Prefix:
First Name:RISA
Middle Name:
Last Name:GILLASPIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S LIMIT AVE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-5118
Mailing Address - Country:US
Mailing Address - Phone:660-826-5885
Mailing Address - Fax:660-826-5174
Practice Address - Street 1:1400 S LIMIT AVE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-5118
Practice Address - Country:US
Practice Address - Phone:660-826-5885
Practice Address - Fax:660-826-5174
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004019011164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse