Provider Demographics
NPI:1811050255
Name:RISSMILLER, RACHEL ROSS (CNM)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ROSS
Last Name:RISSMILLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:J
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:24 MORRILL PL
Mailing Address - Street 2:STE 2
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-3530
Mailing Address - Country:US
Mailing Address - Phone:978-834-8074
Mailing Address - Fax:
Practice Address - Street 1:600 PRIMROSE ST STE 202
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-2659
Practice Address - Country:US
Practice Address - Phone:978-556-0100
Practice Address - Fax:978-556-0101
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA259243367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0711381Medicaid
MARN0344Medicare ID - Type Unspecified
MA0711381Medicaid