Provider Demographics
NPI:1386075133
Name:RILEY, CARLA RENEE (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:RENEE
Last Name:RILEY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MS
Other - First Name:CARLA
Other - Middle Name:RENEE
Other - Last Name:HERRING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:4320 RALEIGH AVE
Mailing Address - Street 2:APT 204
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304
Mailing Address - Country:US
Mailing Address - Phone:513-675-6055
Mailing Address - Fax:
Practice Address - Street 1:4320 RALEIGH AVE
Practice Address - Street 2:APT 204
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304
Practice Address - Country:US
Practice Address - Phone:513-675-6055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001236810163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse