Provider Demographics
NPI:1215041504
Name:RISCH, KAREN A (FNP,CNM)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:A
Last Name:RISCH
Suffix:
Gender:F
Credentials:FNP,CNM
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:A
Other - Last Name:RISCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP,CNM
Mailing Address - Street 1:1288 W GRAND RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48895-9374
Mailing Address - Country:US
Mailing Address - Phone:517-655-7300
Mailing Address - Fax:517-655-7333
Practice Address - Street 1:1288 W GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:MI
Practice Address - Zip Code:48895-9374
Practice Address - Country:US
Practice Address - Phone:517-655-7300
Practice Address - Fax:517-655-7333
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704102151363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00257231Medicare ID - Type Unspecified