Provider Demographics
NPI:1184042780
Name:RIORDAN, KATHERINE COLLEN (MSN, RN, CNL)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:COLLEN
Last Name:RIORDAN
Suffix:
Gender:F
Credentials:MSN, RN, CNL
Other - Prefix:MS
Other - First Name:KAYCE
Other - Middle Name:
Other - Last Name:RIORDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, RN, CNL
Mailing Address - Street 1:2875 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3501
Mailing Address - Country:US
Mailing Address - Phone:773-729-8132
Mailing Address - Fax:773-484-4544
Practice Address - Street 1:2875 W 19TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3501
Practice Address - Country:US
Practice Address - Phone:773-729-8132
Practice Address - Fax:773-484-4544
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.388734163WA2000X, 163WC1500X, 163WD0400X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency