Provider Demographics
NPI:1467240101
Name:RISKO, NICOLE ANNA
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNA
Last Name:RISKO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4333 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9089
Mailing Address - Country:US
Mailing Address - Phone:330-421-9768
Mailing Address - Fax:
Practice Address - Street 1:4333 HAMILTON RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9089
Practice Address - Country:US
Practice Address - Phone:330-421-9768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health