Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 06944 | OH |
NPI | 1033394648 |
---|---|
Provider Name | Ms. Kelley Ann Muldoon Rieger |
First Address | Beachwood, OH 44122-4338 |
Second Address | Beachwood, OH 44122-4338 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2008 |
Last Update Date | 02/01/2008 |