Healthcare Provider Details

I. General information

NPI: 1376081992
Provider Name (Legal Business Name): STEPHANIE RICHARDSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 RESERVOIR DR
ATHOL MA
01331-4901
US

IV. Provider business mailing address

40 ELY RD
DORCHESTER MA
02124-5112
US

V. Phone/Fax

Practice location:
  • Phone: 978-248-5135
  • Fax:
Mailing address:
  • Phone: 617-288-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2266383
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: