Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 2901022128 | MI |
NPI | 1053851311 |
---|---|
Provider Name | Erin Riley |
First Address | Mount Pleasant, MI 48858-1929 |
Second Address | Mount Pleasant, MI 48858-1929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2017 |
Last Update Date | 06/03/2017 |