Provider Demographics
NPI:1033394648
Name:MULDOON RIEGER, KELLEY ANN (APRN)
Entity Type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:ANN
Last Name:MULDOON RIEGER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3733 PARK EAST DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4338
Mailing Address - Country:US
Mailing Address - Phone:216-591-1515
Mailing Address - Fax:216-591-1544
Practice Address - Street 1:3733 PARK EAST DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4338
Practice Address - Country:US
Practice Address - Phone:216-591-1515
Practice Address - Fax:216-591-1544
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06944363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics