Provider Demographics
NPI:1710107230
Name:RIZZOLO, CAROL L (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:L
Last Name:RIZZOLO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 WOOD HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-4333
Mailing Address - Country:US
Mailing Address - Phone:203-250-1292
Mailing Address - Fax:860-628-0218
Practice Address - Street 1:340 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2529
Practice Address - Country:US
Practice Address - Phone:860-628-5767
Practice Address - Fax:860-628-0218
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00286363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant