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NPI Code Detail

MEDICARE: RYAN RAYMOND RILEY CRNA

MEDICARE:   RYAN RAYMOND RILEY  CRNA
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
1367500000XCertified Registered Nurse AnesthetistR 152951-9MN
2367500000XCertified Registered Nurse AnesthetistAPN3269SC

Other Identifiers

General Provider Information

NPI Number : 1457330631
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN RAYMOND RILEY CRNA
Provider Business Mailing Address
First Line : 2000 NORTH AVE
Second Line :
City : NORTHFIELD
State : MN
Zip : 55057-1498
Country : US
Telephone Number : 507-646-1000
Fax Number :
Provider Business Practice Location Address
First Line : 2000 NORTH AVE
Second Line :
City : NORTHFIELD
State : MN
Zip : 55057-1498
Country : US
Telephone Number : 507-646-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2006
Last Update Date : 05/09/2017

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Directions to “ RYAN RAYMOND RILEY CRNA” Practice Location

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