Provider Demographics
NPI:1508915356
Name:RISHELL, GRACE J (NP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:J
Last Name:RISHELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:JAMACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:156 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-7314
Mailing Address - Country:US
Mailing Address - Phone:302-674-2380
Mailing Address - Fax:302-674-1299
Practice Address - Street 1:156 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901
Practice Address - Country:US
Practice Address - Phone:302-674-2380
Practice Address - Fax:302-674-1299
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0000109363LP0808X, 363LP0808X
NY400395363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEL8-0000109OtherPSYCH/MH NURSE PRACTITIONER
S53569Medicare UPIN
NYIA0464Medicare ID - Type Unspecified