Provider Demographics
NPI:1568842664
Name:RIELL, LISA M (CPM, LM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:RIELL
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 TUMBLEWEED TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-7013
Mailing Address - Country:US
Mailing Address - Phone:817-691-0856
Mailing Address - Fax:
Practice Address - Street 1:501 TUMBLEWEED TRL
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7013
Practice Address - Country:US
Practice Address - Phone:817-691-0856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99233175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay