Healthcare Provider Details

I. General information

NPI: 1518479021
Provider Name (Legal Business Name): BRIAN DALE RIFFE LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 TURNERSBURG HWY
STATESVILLE NC
28625-2798
US

IV. Provider business mailing address

318 TURNERSBURG HWY
STATESVILLE NC
28625-2798
US

V. Phone/Fax

Practice location:
  • Phone: 704-873-1114
  • Fax: 704-873-9917
Mailing address:
  • Phone: 704-873-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number79323
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: