Provider Demographics
NPI:1770864829
Name:RILEY, MONICA V (CNP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:V
Last Name:RILEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1859 N PARIS AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-2029
Mailing Address - Country:US
Mailing Address - Phone:912-354-4813
Mailing Address - Fax:912-354-4813
Practice Address - Street 1:25 HOSPITAL CENTER BLVD STE 300
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2739
Practice Address - Country:US
Practice Address - Phone:843-682-2800
Practice Address - Fax:843-682-2828
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH263283363L00000X
SC17990363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC17990OtherLICENSE
SC17990OtherLICENSE