Fennell, Risha Raven

Fennell, Risha Raven is an sole proprietor health care provider with primary practice located at 2501 Chatham Rd Ste 4713 , Springfield IL 62704-4188. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Addiction Medicine. Allopathic & Osteopathic Physicians / Addiction Medicine is her primary health care specialty. Fennell, Risha Raven can be contacted via phone (779) 429-2227.

Contact Information

Primary practice address
2501 Chatham Rd Ste 4713 Springfield IL 62704-4188
Phone: (779) 429-2227
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036100518 Illinois
Allopathic & Osteopathic Physicians / Addiction Medicine 207QA0401X 036100518 Illinois

Profile Details

NPI number 1487622379
LBN Legal business name Fennell, Risha Raven
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 8th, 2006
Last updated Jun 7th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487622379 NPPES
Illinois MEDICAID 036100518

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