Basic Information
| Provider Information | |||||||||
| NPI: | 1740775857 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RILEY | ||||||||
| FirstName: | NATIKA | ||||||||
| MiddleName: | NOELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13539 WYOMING ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482382331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138264382 | ||||||||
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| Practice Location | |||||||||
| Address1: | 33505 SCHOOLCRAFT RD | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481501630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347210200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2018 | ||||||||
| LastUpdateDate: | 06/30/2018 | ||||||||
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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 | 146N00000X | MI | Y | Emergency Medical Service Providers | Emergency Medical Technician, Basic |
No ID Information.