Healthcare Provider Details

I. General information

NPI: 1750611430
Provider Name (Legal Business Name): RICHARD RILEY RN, CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2010
Last Update Date: 01/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 REDBUD LN
EDMOND OK
73034-8038
US

IV. Provider business mailing address

1305 REDBUD LN
EDMOND OK
73034-8038
US

V. Phone/Fax

Practice location:
  • Phone: 405-641-3025
  • Fax:
Mailing address:
  • Phone: 405-641-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: