MEDICARE: MS. MARTHA JANE RICHARDS PNP

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	363LP0200X	Pediatric Nurse Practitioner	NP 6138	CA

General Provider Information

NPI Number	:	1700084753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTHA JANE RICHARDS PNP

Provider Business Mailing Address
First Line	:	1528 HOPKINS ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94707-2711
Country	:	US
Telephone Number	:	510-915-5801
Fax Number	:	925-280-8130

Provider Business Practice Location Address
First Line	:	2123 YGNACIO VALLEY RD
Second Line	:	STE K-100
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-3395
Country	:	US
Telephone Number	:	925-280-8137
Fax Number	:	925-280-8130

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

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	07/10/2007

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