Healthcare Provider Details

I. General information

NPI: 1558116749
Provider Name (Legal Business Name): LEE RICHBURG CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date: 07/30/2024
Reactivation Date: 08/23/2024

III. Provider practice location address

2000 CANAL ST
NEW ORLEANS LA
70112-3018
US

IV. Provider business mailing address

8070 YORKHAVEN RD
MOBILE AL
36695-4902
US

V. Phone/Fax

Practice location:
  • Phone: 504-702-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number224002469
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1-176301
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: