Provider Demographics
NPI:1184058703
Name:RILEY, ASHLEY (FNP)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:DONAHUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST STE 107
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4530
Mailing Address - Country:US
Mailing Address - Phone:781-391-4004
Mailing Address - Fax:781-391-4003
Practice Address - Street 1:101 MAIN ST STE 107
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4530
Practice Address - Country:US
Practice Address - Phone:781-391-4004
Practice Address - Fax:781-391-4003
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2277506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily