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General NPI Number Information
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NPI Number | 1033984554
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Entity Type | Individual
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Provider Name | KATHLEEN MARIE RIORDAN FNP
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Gender | Female
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 249 DAKOTA ST
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City | SUTHERLIN
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State | OR
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Zip | 97479-9908
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Country | US
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Telephone | 541-677-7200
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Fax | 541-229-3309
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Provider Business Mailing Address
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Address Line | 2570 NW EDENBOWER BLVD STE 100
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City | ROSEBURG
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State | OR
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Zip | 97471-6214
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Country | US
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Telephone | 541-677-7200
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Fax | 541-229-3309
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 7923124-4405
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10034451
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License Number State | OR
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