Provider Demographics
NPI:1669411906
Name:RILEY, LARYL R (RNP)
Entity type:Individual
Prefix:
First Name:LARYL
Middle Name:R
Last Name:RILEY
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 WELLS ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2927
Mailing Address - Country:US
Mailing Address - Phone:401-596-6330
Mailing Address - Fax:401-348-0420
Practice Address - Street 1:45 WELLS ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2927
Practice Address - Country:US
Practice Address - Phone:401-596-6330
Practice Address - Fax:401-348-0420
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP20383363L00000X
CT003013363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT500001337Medicare ID - Type Unspecified
RI007009107Medicare ID - Type Unspecified
S61022Medicare UPIN