Provider Demographics
NPI:1861212219
Name:RILEY, COLIN M (PA)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:M
Last Name:RILEY
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:1599 J ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS AFB
Mailing Address - State:ND
Mailing Address - Zip Code:58205-6306
Mailing Address - Country:US
Mailing Address - Phone:701-747-5156
Mailing Address - Fax:
Practice Address - Street 1:1599 J ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS AFB
Practice Address - State:ND
Practice Address - Zip Code:58205-6306
Practice Address - Country:US
Practice Address - Phone:701-747-5156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical