Provider Demographics
NPI:1265000921
Name:RIESINGER, SARAH ANNE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:RIESINGER
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 1:9165 BEARINT WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6465
Mailing Address - Country:US
Mailing Address - Phone:916-769-4162
Mailing Address - Fax:
Practice Address - Street 1:2380 E BIDWELL ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3455
Practice Address - Country:US
Practice Address - Phone:916-306-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant