Provider Demographics
NPI:1295524965
Name:RISLEY, DESHA LOUISE
Entity type:Individual
Prefix:
First Name:DESHA
Middle Name:LOUISE
Last Name:RISLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 PLAYA WAY
Mailing Address - Street 2:APT. 1413
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5697
Mailing Address - Country:US
Mailing Address - Phone:910-303-6953
Mailing Address - Fax:
Practice Address - Street 1:2512 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2571
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other