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NPI Code Detail

MEDICARE: MRS. RACHEL M RICHARDSON PA-C

MEDICARE: MRS. RACHEL M RICHARDSON PA-C
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
1363A00000XPhysician Assistant085004381IL

General Provider Information

NPI Number : 1396705943
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RACHEL M RICHARDSON PA-C
Provider Business Mailing Address
First Line : 9650 GROSS POINT RD STE 2900
Second Line :
City : SKOKIE
State : IL
Zip : 60076-5006
Country : US
Telephone Number : 847-866-7846
Fax Number :
Provider Business Practice Location Address
First Line : 9650 GROSS POINT RD STE 2900
Second Line :
City : SKOKIE
State : IL
Zip : 60076-5006
Country : US
Telephone Number : 847-866-7846
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2006
Last Update Date : 12/02/2021

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