Provider Demographics
NPI:1104329739
Name:RILEY, DEVON CHARLOTTE (CNM)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:CHARLOTTE
Last Name:RILEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 NE NEFF RD STE A
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6752
Mailing Address - Country:US
Mailing Address - Phone:541-389-3300
Mailing Address - Fax:541-389-8115
Practice Address - Street 1:340 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1869
Practice Address - Country:US
Practice Address - Phone:541-526-6635
Practice Address - Fax:541-526-6636
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
OR202104931NP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife