Provider Demographics
NPI:1932465614
Name:RILEY, JUANITA ANN (WHNP)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:ANN
Last Name:RILEY
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:JUANITA
Other - Middle Name:ANN
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 WATERMARK DR
Mailing Address - Street 2:SUITE 420
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1048
Mailing Address - Country:US
Mailing Address - Phone:614-645-5500
Mailing Address - Fax:614-458-1849
Practice Address - Street 1:3433 AGLER RD
Practice Address - Street 2:SUITE 2800
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3387
Practice Address - Country:US
Practice Address - Phone:614-645-1600
Practice Address - Fax:614-645-1347
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12031363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0063891Medicaid