Healthcare Provider Details

I. General information

NPI: 1942287636
Provider Name (Legal Business Name): SUSAN E RICHARDSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN E TIMMERMAN NP

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 GLACIER HWY PLANNED PARENTHOOD
JUNEAU AK
99801-7842
US

IV. Provider business mailing address

3231 GLACIER HWY PLANNED PARENTHOOD
JUNEAU AK
99801-7842
US

V. Phone/Fax

Practice location:
  • Phone: 907-523-5025
  • Fax:
Mailing address:
  • Phone: 907-523-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1696
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number115599
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number309527
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number115598
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: