Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | CP000588 | SD |
NPI | 1235400391 |
---|---|
Provider Name | Angela Ranae Riley |
First Address | Sioux Falls, SD 57105-1007 |
Second Address | Sioux Falls, SD 57105-1007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2012 |
Last Update Date | 21/01/2012 |