Basic Information
| Provider Information | |||||||||
| NPI: | 1356322408 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RILEY | ||||||||
| FirstName: | MADELINE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1624 MAIN STREET | ||||||||
| Address2: | AGAPE SENIOR PRIMARY CARE, INC., DBA AGAPE PHYSICIANS C | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034540365 | ||||||||
| FaxNumber: | 8034046000 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 TRADITION CIRCLE | ||||||||
| Address2: | AGAPE PHYSICIANS CARE | ||||||||
| City: | MT. PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433493096 | ||||||||
| FaxNumber: | 8034046000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 04/01/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 71001527A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 3847 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.