MEDICARE: MS. LYNN ANN RICHARDSON RN, CNS

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	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	R0661711	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	5379824	OTHER	CIGNA
2	6247871	OTHER	UNITED BEHAVIORAL HEALTH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	17F32RI	OTHER	BCBS

General Provider Information

NPI Number	:	1568563864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYNN ANN RICHARDSON RN, CNS

Provider Business Mailing Address
First Line	:	5637 BROOKLYN BLVD
Second Line	:	SUITE 200
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-3081
Country	:	US
Telephone Number	:	763-971-2959
Fax Number	:	763-971-2959

Provider Business Practice Location Address
First Line	:	5637 BROOKLYN BLVD
Second Line	:	SUITE 200
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-3081
Country	:	US
Telephone Number	:	763-971-2959
Fax Number	:	763-971-2959

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	11/26/2008

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