Provider Demographics
NPI:1316193246
Name:RILEY, JAIME M (LPN)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:M
Last Name:RILEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:MARIE
Other - Last Name:ROGALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5188 NOVARA LN
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-8800
Mailing Address - Country:US
Mailing Address - Phone:315-450-8050
Mailing Address - Fax:
Practice Address - Street 1:5188 NOVARA LN
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:NY
Practice Address - Zip Code:13041-8800
Practice Address - Country:US
Practice Address - Phone:315-450-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290111164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse