Individual
PROF. MARILYN J. RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, NP
Contact information
Practice address
1701 N SENATE AVE, 3007, INDIANAPOLIS, IN 46202-5306
(317) 962-5097
(317) 962-5018
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71000828A
IN
363LF0000X
Family Nurse Practitioner
71000828A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001126642
ANTHEM PROVIDER NUMBER
IN
05
—
200843250
—
IN
Enumeration date
11/09/2005
Last updated
03/17/2018
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