Provider Demographics
NPI:1053579631
Name:RISPER, MARY J
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:RISPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 LONGVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1241
Mailing Address - Country:US
Mailing Address - Phone:330-375-1349
Mailing Address - Fax:330-762-4753
Practice Address - Street 1:708 LONGVIEW AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-1241
Practice Address - Country:US
Practice Address - Phone:330-375-1349
Practice Address - Fax:330-762-4753
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2450315Medicaid