Healthcare Provider Details

I. General information

NPI: 1326854084
Provider Name (Legal Business Name): THERESA RILEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2024
Last Update Date: 12/07/2024
Certification Date: 12/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N. HAVEN ST. SUITE 301 OFFICE I
BALTIMORE MD
21224
US

IV. Provider business mailing address

101 N. HAVEN ST. SUITE 301 OFFICE I
BALTIMORE MD
21224
US

V. Phone/Fax

Practice location:
  • Phone: 410-709-2200
  • Fax: 401-433-7902
Mailing address:
  • Phone: 410-709-2273
  • Fax: 401-433-7902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR262577
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberR262577
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR262577
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberR262577
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR262577
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: