Basic Information
| Provider Information | |||||||||
| NPI: | 1477280113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAYLOR | ||||||||
| FirstName: | RILEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | CNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NIBERT | ||||||||
| OtherFirstName: | RILEY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 333 EDDINGTON DR | ||||||||
| Address2: | |||||||||
| City: | PATASKALA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430627330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406456892 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2880 STELZER RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432193133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144722880 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2022 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0031681 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.