Provider Demographics
NPI:1497425680
Name:RILEY, MALLARI LEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MALLARI
Middle Name:LEE
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 1:6104 HILL ST SE
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:OH
Mailing Address - Zip Code:43903-9744
Mailing Address - Country:US
Mailing Address - Phone:740-346-8859
Mailing Address - Fax:
Practice Address - Street 1:4000 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2364
Practice Address - Country:US
Practice Address - Phone:740-264-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.443612163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse