Provider Demographics
NPI:1871583385
Name:RISPOLI, THERESA MARIE (BSN, CNM)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:RISPOLI
Suffix:
Gender:
Credentials:BSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19490 SANDRIDGE WAY STE 350
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3467
Mailing Address - Country:US
Mailing Address - Phone:703-858-5599
Mailing Address - Fax:703-858-5966
Practice Address - Street 1:19490 SANDRIDGE WAY STE 350
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3467
Practice Address - Country:US
Practice Address - Phone:703-858-5599
Practice Address - Fax:703-858-5699
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024162588367A00000X
AZAP7899367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife