Individual
MARY RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 BEVER GRADE, LAPWAI, ID 83540
(208) 843-2271
(208) 843-2658
Mailing address
PO BOX 367, LAPWAI, ID 83540-0367
(208) 843-2271
(208) 843-2658
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
N20110
ID
Other
Enumeration date
08/09/2006
Last updated
07/08/2007
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