Basic Information
| Provider Information | |||||||||
| NPI: | 1396732087 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RILEY | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 WAYMAN LN | ||||||||
| Address2: | |||||||||
| City: | BAR HARBOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046091625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072885081 | ||||||||
| FaxNumber: | 2072888600 | ||||||||
| Practice Location | |||||||||
| Address1: | 394 BAR HARBOR RD | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046055807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076675899 | ||||||||
| FaxNumber: | 2076670184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 03/27/2013 | ||||||||
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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 | CNP81378 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 432017899 | 05 | ME | MEDICAID | R021917 | 01 | ME | RN LICENSE | OTHER | UX9404 | 01 | ME | MEDICARE NUMBER | OTHER | CNP81378 | 01 | ME | APRN LICENSE | OTHER |