Provider Demographics
NPI:1265245492
Name:RILEY, CRISTINA C
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:C
Last Name: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 1:109 FAIR ST
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-1327
Mailing Address - Country:US
Mailing Address - Phone:618-380-6664
Mailing Address - Fax:
Practice Address - Street 1:109 FAIR ST
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1327
Practice Address - Country:US
Practice Address - Phone:618-380-6664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider