Individual provider Active NPI

Joan Kathleen Risse

  • Registered Nurse
  • Santa Rosa, CA
National Provider Identifier
1053684175
Registry record updated Feb 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
219183 Issued in CA
Practice address
112 Childrens Cir
Santa Rosa, CA 95409-6558
Phone
(707) 565-6360
NPI assigned
Feb 21, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 219183 CA Primary

Addresses

Primary practice location

112 Childrens Cir
Santa Rosa, CA 95409-6558

Mailing address

4976 Heather Glen Cir
Santa Rosa, CA 95405-7943
Phone (707) 565-6360

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
219183CAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
County of Sonoma Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329782400000",
    "number": "1053684175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4976 HEATHER GLEN CIR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954057943",
            "telephone_number": "707-565-6360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 CHILDRENS CIR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954096558",
            "telephone_number": "707-565-6360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RISSE",
        "first_name": "JOAN",
        "middle_name": "KATHLEEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-21",
        "last_updated": "2012-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "219183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.