Healthcare Provider Details

I. General information

NPI: 1750746491
Provider Name (Legal Business Name): JOHN DANIEL RICHARDSON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 SPRING HILL AVE
MOBILE AL
36607-1822
US

IV. Provider business mailing address

254 BURGUNDY AVE
FAIRHOPE AL
36532-1510
US

V. Phone/Fax

Practice location:
  • Phone: 251-287-8420
  • Fax:
Mailing address:
  • Phone: 601-323-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-146621
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: