Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 30284 | TN |
NPI | 1053081406 |
---|---|
Provider Name | Olivia Riley |
First Address | Memphis, TN 38119-5223 |
Second Address | Memphis, TN 38119-5223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2021 |
Last Update Date | 16/09/2021 |