Provider Demographics
NPI:1720800477
Name:ELDER, RILEY WILLIAM MATTILA
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:WILLIAM MATTILA
Last Name:ELDER
Suffix:
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 1:315 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115
Mailing Address - Country:US
Mailing Address - Phone:615-732-7662
Mailing Address - Fax:
Practice Address - Street 1:315 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115
Practice Address - Country:US
Practice Address - Phone:615-732-7662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN251031163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine