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General NPI Number Information
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NPI Number | 1609416429
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Entity Type | Individual
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Provider Name | DYLAN J RILEY
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Gender | Male
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Dates
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Enumeration Date | 01/09/2020
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 8000 E MAPLEWOOD AVE STE 200
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-4727
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Country | US
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Telephone | 303-783-4907
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Fax |
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Provider Business Mailing Address
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Address Line | 1039 HYLAND DR
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City | EVERGREEN
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State | CO
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Zip | 80439-4813
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Country | US
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Telephone | 970-640-6478
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Fax |
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 0202705
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 0995274
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License Number State | CO
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