MEDICARE: JANICE RICHARDSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	95060828	CA

General Provider Information

NPI Number	:	1073127841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE RICHARDSON

Provider Business Mailing Address
First Line	:	15986 TURTLE BAY PL
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-4543
Country	:	US
Telephone Number	:	909-641-8191
Fax Number	:

Provider Business Practice Location Address
First Line	:	15986 TURTLE BAY PL
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-4543
Country	:	US
Telephone Number	:	909-641-8191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2020
Last Update Date	:	08/31/2020

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