Healthcare Provider Details

I. General information

NPI: 1376885889
Provider Name (Legal Business Name): JENNIFER RILEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER BUNIO MD

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49725 COUNTY 83
STAPLES MN
56479-5280
US

IV. Provider business mailing address

1601GOLD COURSE RD
GRAND RAPIDS MN
55744
US

V. Phone/Fax

Practice location:
  • Phone: 218-894-1515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number61907
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: