Individual
MS. SHANNON ROSE RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
63 MAIN ST, BROCKTON, MA 02301-4042
(508) 559-6699
Mailing address
63 MAIN ST, BROCKTON, MA 02301-4042
(508) 559-6699
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2301935
MA
363L00000X
Nurse Practitioner
Primary
RN2301935
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/02/2021
Last updated
08/12/2022
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