Healthcare Provider Details

I. General information

NPI: 1952949729
Provider Name (Legal Business Name): CAROLYN NIGHTINGALE RIKER MSN, CPNP-AC/PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3175
US

IV. Provider business mailing address

79 NONANTUM ST
BOSTON MA
02135-2452
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-2934
  • Fax:
Mailing address:
  • Phone: 207-469-5585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2286242
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberCNP241619
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: