Healthcare Provider Details

I. General information

NPI: 1881873388
Provider Name (Legal Business Name): ANDREA ARTA RILEY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 DEMOSS STREET
LORDSBURG NM
88045-2618
US

IV. Provider business mailing address

1213 24TH ST STE 100
ANACORTES WA
98221-2595
US

V. Phone/Fax

Practice location:
  • Phone: 575-542-8384
  • Fax: 575-542-8387
Mailing address:
  • Phone: 575-542-8384
  • Fax: 575-542-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberLD0681
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60134099
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR62680
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: