Healthcare Provider Details

I. General information

NPI: 1336705839
Provider Name (Legal Business Name): MS. ROSE-ANN CASHEMA RICHARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 DIXWELL AVE
HAMDEN CT
06514-2405
US

IV. Provider business mailing address

2045 DIXWELL AVE
HAMDEN CT
06514-2405
US

V. Phone/Fax

Practice location:
  • Phone: 203-287-0835
  • Fax:
Mailing address:
  • Phone: 203-287-0835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2018071290
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8155
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: