Provider Demographics
NPI:1265125983
Name:BLUMENBERG-RILEY, VIRLASTENE
Entity type:Individual
Prefix:MRS
First Name:VIRLASTENE
Middle Name:
Last Name:BLUMENBERG-RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29710 HANOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5178
Mailing Address - Country:US
Mailing Address - Phone:313-743-3131
Mailing Address - Fax:
Practice Address - Street 1:29710 HANOVER BLVD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5178
Practice Address - Country:US
Practice Address - Phone:313-743-3131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB455847018675374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty