Provider Demographics
NPI:1164984746
Name:RISNER, ALICE LYNN (CNP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:LYNN
Last Name:RISNER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:LYNN
Other - Last Name:PFOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:136 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-3704
Mailing Address - Country:US
Mailing Address - Phone:740-751-6380
Mailing Address - Fax:740-751-4866
Practice Address - Street 1:136 W CENTER ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-3704
Practice Address - Country:US
Practice Address - Phone:740-751-6380
Practice Address - Fax:740-751-4866
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily