Healthcare Provider Details

I. General information

NPI: 1720368525
Provider Name (Legal Business Name): DORIS ANN RICHIE RDMS, RVT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 E. 12TH ST.
DANVILLE AR
72833-1029
US

IV. Provider business mailing address

804 EAST 12TH ST
DANVILLE AR
72833-1029
US

V. Phone/Fax

Practice location:
  • Phone: 479-495-7265
  • Fax:
Mailing address:
  • Phone: 479-495-7265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: