Provider Demographics
NPI:1447477070
Name:RISSLER, ANITA B (CNM)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:B
Last Name:RISSLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 HAILEY RD
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-5077
Mailing Address - Country:US
Mailing Address - Phone:870-423-2923
Mailing Address - Fax:870-423-5315
Practice Address - Street 1:402 HAILEY RD
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-5077
Practice Address - Country:US
Practice Address - Phone:870-423-2923
Practice Address - Fax:870-423-5315
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARM00127367A00000X, 176B00000X
ARM000127367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T299OtherAR BLUE SHIELD #
AR129047799Medicaid
AR5T299OtherAR BLUE SHIELD PROV. #
AR5T299OtherAR BLUE SHIELD #
AR5T299Medicare ID - Type UnspecifiedAR MDCR PROV. #