Provider Demographics
NPI:1710325436
Name:RILEY, MARSHA MARIE
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:MARIE
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:MARY
Other - Last Name:COLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:BNC COMPLEX SUITE# 215
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-0528
Mailing Address - Country:US
Mailing Address - Phone:907-543-1784
Mailing Address - Fax:907-543-3152
Practice Address - Street 1:460 RIDGECREST
Practice Address - Street 2:SUITE#: 215
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559-0528
Practice Address - Country:US
Practice Address - Phone:907-543-1784
Practice Address - Fax:907-543-3152
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1002447Medicaid