Individual
MR. RANDAL ANTHONY RILEY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
4363 W DEAN RD APT 164, BROWN DEER, WI 53223-3100
(305) 978-2335
Mailing address
5826 W BOEHLKE AVE APT 4, MILWAUKEE, WI 53223-5292
(305) 978-2335
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
252849-30
WI
164W00000X
Licensed Practical Nurse
321568
WI
Other
Enumeration date
09/29/2018
Last updated
05/07/2020
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