Healthcare Provider Details

I. General information

NPI: 1790821064
Provider Name (Legal Business Name): PATRICE AVA-DAWN RICHARDSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 MEDICAL PKWY 102
ANNAPOLIS MD
21401-7992
US

IV. Provider business mailing address

PO BOX 12622
BELFAST ME
04915-4017
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1000
  • Fax: 443-481-1687
Mailing address:
  • Phone: 443-481-6560
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number232168
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number232168
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: