Provider Demographics
NPI:1609638360
Name:RILEY, STACY L
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:RILEY
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 1:5892 STUDEBAKER RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-9407
Mailing Address - Country:US
Mailing Address - Phone:937-559-5128
Mailing Address - Fax:
Practice Address - Street 1:5892 STUDEBAKER RD
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45344-9407
Practice Address - Country:US
Practice Address - Phone:937-559-5128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant