Individual
MADELINE JANE RISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
5450 FORT ST, TRENTON, MI 48183-4601
(734) 642-2340
Mailing address
20110 HCL JACKSON, GROSSE ILE, MI 48138-1102
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704348468
MI
363LF0000X
Family Nurse Practitioner
Primary
4704348468
MI
Other
Enumeration date
01/11/2024
Last updated
08/12/2024
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