Individual
MARY RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4348 ELECTRIC RD, ROANOKE, VA 24018-0720
(540) 769-0976
(540) 857-5386
Mailing address
1030 S JEFFERSON ST STE 201, ROANOKE, VA 24016-4418
(540) 224-4520
(540) 342-1649
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
0024175894
VA
363LP0200X
Pediatric Nurse Practitioner
R218970
MD
Other
Enumeration date
10/26/2016
Last updated
11/05/2021
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