Provider Demographics
NPI:1861917213
Name:RILEY, TA'NEISHA MONIQUE-GRADY (LVN)
Entity type:Individual
Prefix:MRS
First Name:TA'NEISHA
Middle Name:MONIQUE-GRADY
Last Name:RILEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:TA'NEISHA
Other - Middle Name:MONIQUE
Other - Last Name:GRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:13685 HEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-0714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9890 COUNTY FARM RD BLDG 3
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3505
Practice Address - Country:US
Practice Address - Phone:951-509-8336
Practice Address - Fax:951-509-8333
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280538164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse