Provider Demographics
NPI:1386452183
Name:RILEY, NASHAWN KENNETH I
Entity type:Individual
Prefix:
First Name:NASHAWN
Middle Name:KENNETH
Last Name:RILEY
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 BROOKS DR APT T17
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1084
Mailing Address - Country:US
Mailing Address - Phone:301-836-8621
Mailing Address - Fax:
Practice Address - Street 1:2110 BROOKS DR APT T17
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-1084
Practice Address - Country:US
Practice Address - Phone:301-836-8621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC44835173747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant