Provider Demographics
NPI:1679917298
Name:RISHEL, TAMMY RENE (PA-C)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:RENE
Last Name:RISHEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:155 S ARCH ST STE B
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-1172
Practice Address - Country:US
Practice Address - Phone:570-742-2655
Practice Address - Fax:570-742-2886
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2020-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA055940363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA459798F6KMedicare PIN