Provider Demographics
NPI:1083346902
Name:RILEY, H KATHLEEN (RN)
Entity Type:Individual
Prefix:
First Name:H
Middle Name:KATHLEEN
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 1:6545 DIX RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-8019
Mailing Address - Country:US
Mailing Address - Phone:315-725-6950
Mailing Address - Fax:
Practice Address - Street 1:MVPC ROME CLINIC
Practice Address - Street 2:227 W DOMINICK ST
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440
Practice Address - Country:US
Practice Address - Phone:315-336-6230
Practice Address - Fax:315-337-9262
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY682625163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse