Healthcare Provider Details

I. General information

NPI: 1386801504
Provider Name (Legal Business Name): STEPHANIE LYNNE RILEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE LYNNE PATTON MD

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4564 DRIFTWOOD LN
GREENWOOD IN
46143-8164
US

IV. Provider business mailing address

PO BOX 1329
BLOOMINGTON IN
47402-1329
US

V. Phone/Fax

Practice location:
  • Phone: 317-502-0884
  • Fax:
Mailing address:
  • Phone: 812-353-9816
  • Fax: 812-353-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301092010
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301092010
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01069356A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: