Provider Demographics
NPI:1891880944
Name:RIKER, ANNE E (PAC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:E
Last Name:RIKER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 FERNCLIFF ROAD
Mailing Address - Street 2:
Mailing Address - City:POULTNEY
Mailing Address - State:VT
Mailing Address - Zip Code:05764
Mailing Address - Country:US
Mailing Address - Phone:802-287-2073
Mailing Address - Fax:
Practice Address - Street 1:17 MADISON STREET
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:NY
Practice Address - Zip Code:12832
Practice Address - Country:US
Practice Address - Phone:518-642-2710
Practice Address - Fax:518-642-1318
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0001611363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R88837Medicare UPIN