Provider Demographics
NPI:1356322408
Name:RILEY, MADELINE (FNP)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1624 MAIN STREET
Mailing Address - Street 2:AGAPE SENIOR PRIMARY CARE, INC., DBA AGAPE PHYSICIANS C
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-454-0365
Mailing Address - Fax:803-404-6000
Practice Address - Street 1:3100 TRADITION CIRCLE
Practice Address - Street 2:AGAPE PHYSICIANS CARE
Practice Address - City:MT. PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466
Practice Address - Country:US
Practice Address - Phone:843-349-3096
Practice Address - Fax:803-404-6000
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71001527A363LF0000X
SC3847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4173Medicare PIN
INQ52987Medicare UPIN