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Individual

DR. PAMELA RAE DEANE RILEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
AUD., CCC-A

Contact information

Practice address
919 E JEFFERSON BLVD STE 104, SOUTH BEND, IN 46617-3115
(574) 232-5815
(574) 289-4327
Mailing address
919 E JEFFERSON BLVD STE 104, SOUTH BEND, IN 46617-3115
(574) 232-5815
(574) 289-4327

Taxonomy

Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
23002137A
IN
237600000X
Audiologist-Hearing Aid Fitter
3501002824
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000247031
ANTHEM PROVIDER
IN
Enumeration date
08/31/2006
Last updated
07/09/2007
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