Healthcare Provider Details

I. General information

NPI: 1821801614
Provider Name (Legal Business Name): RILY MARIE POLING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32789 W 168TH ST APT SUITE
LAWSON MO
64062-8271
US

IV. Provider business mailing address

32789 W 168TH ST APT SUITE
LAWSON MO
64062-8271
US

V. Phone/Fax

Practice location:
  • Phone: 816-912-7923
  • Fax:
Mailing address:
  • Phone: 816-912-7923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2023026880
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: