Healthcare Provider Details

I. General information

NPI: 1376138818
Provider Name (Legal Business Name): HOLLY RIEKEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2021
Last Update Date: 02/01/2026
Certification Date: 02/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR
WRIGHT PATTERSON AFB OH
45433-5529
US

IV. Provider business mailing address

128 E APPLE ST STE 7000
DAYTON OH
45409-2902
US

V. Phone/Fax

Practice location:
  • Phone: 937-257-0837
  • Fax:
Mailing address:
  • Phone: 937-208-2177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2023038398
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: