Healthcare Provider Details

I. General information

NPI: 1144556663
Provider Name (Legal Business Name): KATHLEEN MEGAN RILEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 EGG HARBOR RD SUITE C-2
SEWELL NJ
08080-2359
US

IV. Provider business mailing address

570 EGG HARBOR RD SUITE C-2
SEWELL NJ
08080-2359
US

V. Phone/Fax

Practice location:
  • Phone: 856-218-0300
  • Fax: 856-589-9487
Mailing address:
  • Phone: 856-218-0300
  • Fax: 856-589-9487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number067625-23
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM122007
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: