Provider Demographics
NPI:1144396862
Name:DORWEILER, RISA ANN (NP)
Entity type:Individual
Prefix:
First Name:RISA
Middle Name:ANN
Last Name:DORWEILER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1221 W LAKE ST
Mailing Address - Street 2:#208
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3397
Mailing Address - Country:US
Mailing Address - Phone:612-455-3200
Mailing Address - Fax:612-455-3299
Practice Address - Street 1:400 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-1408
Practice Address - Country:US
Practice Address - Phone:320-589-1313
Practice Address - Fax:320-589-1065
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 123282-2363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN187282600Medicaid
MN500003964Medicare PIN