Provider Demographics
NPI:1013998574
Name:RIESLAND, RODNEY (NP)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:RIESLAND
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-0220
Mailing Address - Country:US
Mailing Address - Phone:906-225-3910
Mailing Address - Fax:906-225-4529
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:STE 344
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-225-3910
Practice Address - Fax:906-225-4529
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI205362363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00045838OtherRAILROAD MEDICARE
MI4517925Medicaid
MI381358036011OtherTRICARE
MIP00045838OtherRAILROAD MEDICARE
MI4517925Medicaid