Provider Demographics
NPI:1750989711
Name:RIZZO, RAE ANN
Entity type:Individual
Prefix:
First Name:RAE
Middle Name:ANN
Last Name:RIZZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:TOWER CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58071-4221
Mailing Address - Country:US
Mailing Address - Phone:701-429-0053
Mailing Address - Fax:
Practice Address - Street 1:202 2ND ST
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:ND
Practice Address - Zip Code:58064-4115
Practice Address - Country:US
Practice Address - Phone:701-668-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND14731503747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant