Healthcare Provider Details

I. General information

NPI: 1891428124
Provider Name (Legal Business Name): RILEY OTTEN REED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3176 LANCER ST
PORTAGE IN
46368-4408
US

IV. Provider business mailing address

601 WALL ST
VALPARAISO IN
46383-2512
US

V. Phone/Fax

Practice location:
  • Phone: 219-762-9557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28249452A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: