Provider Demographics
NPI:1609464239
Name:RILEY, NICHOLE MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:MARIE
Last Name:RILEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:MARIE
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-RX, FNP-C
Mailing Address - Street 1:4225 ALTAMONT PL STE 203
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3065
Mailing Address - Country:US
Mailing Address - Phone:302-375-8080
Mailing Address - Fax:
Practice Address - Street 1:4225 ALTAMONT PL STE 203
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3065
Practice Address - Country:US
Practice Address - Phone:301-375-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022945363LF0000X
MDR259567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily