Provider Demographics
NPI:1396251872
Name:RILEY, ELAINA MARIE (PNP)
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:MARIE
Last Name:RILEY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
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Mailing Address - Street 1:3226 HIDDEN TIMBER DR STE A
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1598
Mailing Address - Country:US
Mailing Address - Phone:248-499-6630
Mailing Address - Fax:
Practice Address - Street 1:43097 WOODWARD AVE STE 201
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5043
Practice Address - Country:US
Practice Address - Phone:248-454-9000
Practice Address - Fax:248-581-8707
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2023-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704300050363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics