Provider Demographics
NPI:1417199563
Name:RISNER, TAMERA JOAN (STNA)
Entity Type:Individual
Prefix:MRS
First Name:TAMERA
Middle Name:JOAN
Last Name:RISNER
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 BROADVIEW ST APT E
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-9656
Mailing Address - Country:US
Mailing Address - Phone:419-310-8071
Mailing Address - Fax:
Practice Address - Street 1:171 BROADVIEW ST APT E
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-9656
Practice Address - Country:US
Practice Address - Phone:419-310-8071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400312811203376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide