Provider Demographics
NPI:1801423355
Name:RIESEL, HANNAH ROSE (NP)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:ROSE
Last Name:RIESEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 ISLAND ST STE 94
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1835
Mailing Address - Country:US
Mailing Address - Phone:315-868-9141
Mailing Address - Fax:
Practice Address - Street 1:60 ISLAND ST STE 94
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1835
Practice Address - Country:US
Practice Address - Phone:315-868-9141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2311616363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110162908AMedicaid