Provider Demographics
NPI:1780736413
Name:RIACH, CHARLENE H (RN,MS,C-FNP)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:H
Last Name:RIACH
Suffix:
Gender:F
Credentials:RN,MS,C-FNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:236 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-4008
Mailing Address - Country:US
Mailing Address - Phone:845-895-7156
Mailing Address - Fax:845-895-7173
Practice Address - Street 1:90 ROBINSON DR.
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589-4008
Practice Address - Country:US
Practice Address - Phone:845-895-7156
Practice Address - Fax:845-895-7173
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330109-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMR 0061262OtherDEA #