Provider Demographics
NPI:1376010033
Name:RISHER, AVERY
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:RISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 E SUNSET RD APT 2016
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3987
Mailing Address - Country:US
Mailing Address - Phone:702-479-9382
Mailing Address - Fax:
Practice Address - Street 1:6941 SILVER BANGLE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-8305
Practice Address - Country:US
Practice Address - Phone:702-479-8392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care