Provider Demographics
NPI:1750489126
Name:RILEY, NANNETTE C (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:NANNETTE
Middle Name:C
Last Name:RILEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16367
Mailing Address - Street 2:1201 PATTON AVE
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28816-0367
Mailing Address - Country:US
Mailing Address - Phone:828-252-4878
Mailing Address - Fax:828-252-4103
Practice Address - Street 1:1201 PATTON AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2707
Practice Address - Country:US
Practice Address - Phone:828-252-4878
Practice Address - Fax:828-252-4103
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV53690363LF0000X, 363LP0200X
NC5005401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCBINP08055OtherMEDICAREID-TYPE UNSPECIFIED
NC7104053000Medicaid
001721062OtherBCBS
NC7104053000Medicaid