Provider Demographics
NPI:1477194074
Name:RILEY, NATALEE R (LPN)
Entity Type:Individual
Prefix:MS
First Name:NATALEE
Middle Name:R
Last Name:RILEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 COMMERCIAL AVE APT C
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528
Mailing Address - Country:US
Mailing Address - Phone:845-337-9855
Mailing Address - Fax:
Practice Address - Street 1:6 COMMERCIAL AVE APT C
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528
Practice Address - Country:US
Practice Address - Phone:845-337-9855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287946-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse