Provider Demographics
NPI:1760586465
Name:RILEY, SUSAN (CNM)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MOUNTAIN LAURELS DR
Mailing Address - Street 2:UNIT 201
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-2249
Mailing Address - Country:US
Mailing Address - Phone:603-888-4394
Mailing Address - Fax:
Practice Address - Street 1:21 E HOLLIS ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2928
Practice Address - Country:US
Practice Address - Phone:603-577-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH015405-23-01367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30002241Medicaid
NHRE4225Medicare ID - Type Unspecified
NHS26334Medicare UPIN