Healthcare Provider Details

I. General information

NPI: 1194807826
Provider Name (Legal Business Name): MARY J RILEY BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 SHOSHONE CIR
ELKO NV
89801-5072
US

IV. Provider business mailing address

515 SHOSHONE CIR
ELKO NV
89801-5072
US

V. Phone/Fax

Practice location:
  • Phone: 775-738-2252
  • Fax: 775-778-0521
Mailing address:
  • Phone: 775-738-2252
  • Fax: 775-778-0521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN059857
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: