Healthcare Provider Details

I. General information

NPI: 1851061014
Provider Name (Legal Business Name): EMILY LYNN RILEY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE
BOSTON MA
02215-5418
US

IV. Provider business mailing address

55 N MAIN ST
IPSWICH MA
01938-2236
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-6140
  • Fax: 617-632-4422
Mailing address:
  • Phone: 518-928-6458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2296929
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN2296929
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: