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Individual
MRS. NANNETTE C RILEY
Active
Individual
MRS. NANNETTE C RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5005401
NC
363LF0000X
Family Nurse Practitioner
53690
WV
363LP0200X
Pediatric Nurse Practitioner
53690
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001721062
BCBS
—
05
—
7104053000
—
NC
01
—
BINP08055
MEDICAREID-TYPE UNSPECIFIED
NC
Enumeration date
09/20/2006
Last updated
11/02/2011
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