Provider Demographics
NPI:1558054403
Name:RILLEY, QIANA
Entity Type:Individual
Prefix:
First Name:QIANA
Middle Name:
Last Name:RILLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6453 N 81ST ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-5507
Mailing Address - Country:US
Mailing Address - Phone:414-292-8119
Mailing Address - Fax:
Practice Address - Street 1:6453 N 81ST ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-5507
Practice Address - Country:US
Practice Address - Phone:414-292-8119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)