Etta Marie Riley, CEO/OWNER

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

License

M933160273015 Issued in MN

Practice address

3622 Penn Ave N
Minneapolis, MN 55412-1934

Phone

(612) 522-3370

NPI assigned

Dec 23, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1577059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577059200000",
    "number": "1912546938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3622 PENN AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554121934",
            "telephone_number": "612-522-3370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3622 PENN AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554121934",
            "telephone_number": "612-522-3370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RILEY",
        "first_name": "ETTA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "CEO/OWNER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-23",
        "last_updated": "2019-12-23",
        "certification_date": "2019-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "MN",
            "license": "M933160273015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Fri Rih Reh
• Eric I Riklin, PHD, LP
• Abigail Marie Riley, MS
• Amya Aaliyana Riley
• Christine Riley, MS, LPCC
• Gregg Riley, LP
• Linda Hale Riley, MD
• Monique A Riley
• Dirck Anthony Rilla, CCP
• Rimal

• Non-emergency Medical Transport (VAN) in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Non-emergency Medical Transport (VAN) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.