Provider Demographics
NPI:1750611430
Name:RILEY, RICHARD (RN, CNIM)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:RILEY
Suffix:
Gender:M
Credentials:RN, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 REDBUD LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-8038
Mailing Address - Country:US
Mailing Address - Phone:405-641-3025
Mailing Address - Fax:
Practice Address - Street 1:1305 REDBUD LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-8038
Practice Address - Country:US
Practice Address - Phone:405-641-3025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-03
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic