Healthcare Provider Details

I. General information

NPI: 1922639293
Provider Name (Legal Business Name): MEREDITH ELLEN RIKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122A HIGHLAND AVE
SAN FRANCISCO CA
94110-5811
US

IV. Provider business mailing address

122A HIGHLAND AVE
SAN FRANCISCO CA
94110-5811
US

V. Phone/Fax

Practice location:
  • Phone: 207-831-3266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP61014368
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: