Healthcare Provider Details

I. General information

NPI: 1669916623
Provider Name (Legal Business Name): LOURDES RICHARDSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2016
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 159TH ST STE A-B
OAK FOREST IL
60452-2725
US

IV. Provider business mailing address

22953 TOSCANA DR
FRANKFORT IL
60423-9056
US

V. Phone/Fax

Practice location:
  • Phone: 708-687-4620
  • Fax: 708-687-4625
Mailing address:
  • Phone: 708-351-9599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015247
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041273555
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: