Provider Demographics
NPI:1053157040
Name:RISTON, LISA LYNN (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:RISTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:LYNN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:625 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-2111
Mailing Address - Country:US
Mailing Address - Phone:910-987-3272
Mailing Address - Fax:
Practice Address - Street 1:625 STATE ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2111
Practice Address - Country:US
Practice Address - Phone:910-987-3272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY837080163W00000X
NC334093163W00000X
OH502627163W00000X
OK209736163W00000X
PARN750262163W00000X
RIRN70608163W00000X
IA179063163W00000X
KS14-162-670-111163W00000X
NM65168163W00000X
MI4704295765163W00000X
AL1-186919163W00000X
AR227940163W00000X
CO1689599163W00000X
IL41510132163W00000X
GARN318073163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse