MEDICARE: DR. NICOLA IRENE RILEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	56658201205	UT

General Provider Information

NPI Number	:	1841261211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLA IRENE RILEY MD

Provider Business Mailing Address
First Line	:	10414 S WASATCH BLVD
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-4555
Country	:	US
Telephone Number	:	801-913-2079
Fax Number	:

Provider Business Practice Location Address
First Line	:	10414 S WASATCH BLVD
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-4555
Country	:	US
Telephone Number	:	801-915-2978
Fax Number	:	801-942-9201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	11/07/2017

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