Provider Demographics
NPI:1902467434
Name:RILEY, JOLENE (RN)
Entity Type:Individual
Prefix:MS
First Name:JOLENE
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19776 SE STARK ST UNIT 46
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-6084
Mailing Address - Country:US
Mailing Address - Phone:360-624-0132
Mailing Address - Fax:
Practice Address - Street 1:4115 SE HAGER LN
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2925
Practice Address - Country:US
Practice Address - Phone:503-654-7115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR087000385RN163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice