Individual
MRS. MARY SUSAN RIYANTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
6300 HARRY HINES BLVD., SUITE 600, DALLAS, TX 75235
(214) 266-0130
Mailing address
5200 HARRY HINES BLVD, DALLAS, TX 75235-7709
(469) 419-1342
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
666550
TX
Other
Enumeration date
01/08/2014
Last updated
10/10/2022
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