Healthcare Provider Details

I. General information

NPI: 1659593853
Provider Name (Legal Business Name): COLETHA RILEY CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 TULANE AVE RM 505
NEW ORLEANS LA
70112-2821
US

IV. Provider business mailing address

1541 TULANE AVE RM 505
NEW ORLEANS LA
70112-2821
US

V. Phone/Fax

Practice location:
  • Phone: 504-903-5163
  • Fax:
Mailing address:
  • Phone: 504-903-5163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberRN039432
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: