Provider Demographics
NPI:1871822585
Name:RIESCH, LOU W (CNS)
Entity Type:Individual
Prefix:
First Name:LOU
Middle Name:W
Last Name:RIESCH
Suffix:
Gender:M
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6500 N MO PAC EXPY
Mailing Address - Street 2:BUILDING. 3, SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3282
Mailing Address - Country:US
Mailing Address - Phone:512-458-8400
Mailing Address - Fax:512-458-8593
Practice Address - Street 1:6500 N MO PAC EXPY
Practice Address - Street 2:BUILDING. 3, SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3282
Practice Address - Country:US
Practice Address - Phone:512-458-8400
Practice Address - Fax:512-458-8593
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX733858364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L23302Medicare PIN
TXTXB118901Medicare PIN