Provider Demographics
NPI:1265018527
Name:RILEY, CARLEEN BOWMAN
Entity Type:Individual
Prefix:
First Name:CARLEEN
Middle Name:BOWMAN
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLEEN
Other - Middle Name:
Other - Last Name:BOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1195 SAINT MATTHEWS RD STE 336
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-3417
Mailing Address - Country:US
Mailing Address - Phone:803-570-6306
Mailing Address - Fax:
Practice Address - Street 1:904 OAKLANE DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-8121
Practice Address - Country:US
Practice Address - Phone:803-290-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion