Provider Demographics
NPI:1417175167
Name:RIZNYK, MICHAEL JOHN (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:RIZNYK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 HATFIELD CT
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-1126
Mailing Address - Country:US
Mailing Address - Phone:910-738-3358
Mailing Address - Fax:910-738-9174
Practice Address - Street 1:404 HATFIELD CT
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-1126
Practice Address - Country:US
Practice Address - Phone:910-738-3358
Practice Address - Fax:910-738-9174
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000720363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant