Healthcare Provider Details

I. General information

NPI: 1932465614
Provider Name (Legal Business Name): JUANITA ANN RILEY WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUANITA ANN WILKINSON

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 AGLER RD SUITE 2800
COLUMBUS OH
43219-3387
US

IV. Provider business mailing address

1800 WATERMARK DR SUITE 420
COLUMBUS OH
43215-1048
US

V. Phone/Fax

Practice location:
  • Phone: 614-645-1600
  • Fax: 614-645-1347
Mailing address:
  • Phone: 614-645-5500
  • Fax: 614-458-1849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCOA.12031
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: