1386075133 NPI number — MS. CARLA RENEE RILEY REGISTERED NURSE

Table of content: MS. CARLA RENEE RILEY REGISTERED NURSE (NPI 1386075133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386075133 NPI number — MS. CARLA RENEE RILEY REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RILEY
Provider First Name:
CARLA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HERRING
Provider Other First Name:
CARLA
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
REGISTERED NURSE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386075133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4320 RALEIGH AVE
Provider Second Line Business Mailing Address:
APT 204
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-675-6055
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4320 RALEIGH AVE
Provider Second Line Business Practice Location Address:
APT 204
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-675-6055
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  0001236810 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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