Provider Demographics
NPI:1053757112
Name:RILEY, JUDITH ANN (RN)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:RILEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S. CRAPO ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-772-5938
Mailing Address - Fax:989-779-2371
Practice Address - Street 1:301 S CRAPO ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2941
Practice Address - Country:US
Practice Address - Phone:989-772-5938
Practice Address - Fax:989-779-2371
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704143227163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health