Provider Demographics
NPI:1265527618
Name:RILEY, MAUREEN B (CRNA, BSN, MAE)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:B
Last Name:RILEY
Suffix:
Gender:F
Credentials:CRNA, BSN, MAE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81024
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85069-1024
Mailing Address - Country:US
Mailing Address - Phone:602-525-4977
Mailing Address - Fax:602-938-4954
Practice Address - Street 1:10701 W BELL RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-1074
Practice Address - Country:US
Practice Address - Phone:602-525-4977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN060004367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ132548Medicaid
AZ132548Medicaid
AZR09114Medicare UPIN