MEDICARE: SARAH RILEY FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704268690	MI

General Provider Information

NPI Number	:	1043982853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH RILEY FNP

Provider Business Mailing Address
First Line	:	333 N SUMMIT ST FL 7
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-1531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 E CHICAGO ST
Second Line	:
City	:	COLDWATER
State	:	MI
Zip	:	49036-2074
Country	:	US
Telephone Number	:	517-279-5214
Fax Number	:	517-279-5488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	06/09/2022

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