Individual
JUDY R RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1615 BLEWER RD, COPE, SC 29038-9330
(803) 596-2778
Mailing address
1615 BLEWER RD, COPE, SC 29038-9330
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
47649
SC
Other
Enumeration date
11/11/2019
Last updated
11/11/2019
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