Breanna Riesgraf, NP
Individual provider Active NPI Family Nurse Practitioner · Marathon, WI
NPI 1699321463 · NPPES record last updated Aug 16, 2019
Key facts
- NPI
- 1699321463
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 9339-33 (WI)
- Practice address
- 670 Community Cir
Marathon, WI 54448-9003 - Phone
- (715) 443-6767
- NPI assigned
- Aug 16, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191008002188 | WI | Practitioner - Nurse Practitioner | 8729319660 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9339-33 | WI | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aspirus Medical Group, Inc. | Current |
Accepting new patients | |
| Aspirus Medical Group, Inc. | Current | Accepting new patients | |
| Aspirus Medical Group, Inc. | Current |
Accepting new patients |
Locations
29980 Network Pl
Chicago, IL 60673
670 Community Cir
Marathon, WI 54448
Phone (715) 443-6767
333 Pine Ridge Blvd
Ste 185
Wausau, WI 54401
Phone (715) 847-0477
333 Pine Ridge Blvd
Wausau, WI 54401
Phone (715) 847-2160
Interoperability endpoints
- telemed2u.breannariesgraf@160918.advancedmd-direct.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 9339-33 | WI | Yes |
Addresses
Primary practice location
670 Community Cir
Marathon, WI 54448-9003
Mailing address
670 Community Cir
Marathon, WI 54448-9003
Other providers in Marathon, WI
- Jean E Matushak
- Sharon Louise Muttonen
- Leah Oonk
- Osl Marathon Operating LLC
- Raymond M Goga
- Brian Gerard Stieber
- Michael James Strong
- Julie Volhard
All providers in Marathon, WI · Family Nurse Practitioner in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.