Provider Demographics
NPI:1598040388
Name:RILEY, AMANDA (CRNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 ROUTE 88 STE A
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-2373
Mailing Address - Country:US
Mailing Address - Phone:732-836-3200
Mailing Address - Fax:732-836-3201
Practice Address - Street 1:1541 ROUTE 88 STE A
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-2373
Practice Address - Country:US
Practice Address - Phone:732-836-3200
Practice Address - Fax:732-836-3201
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR234066363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner