Healthcare Provider Details

I. General information

NPI: 1275418519
Provider Name (Legal Business Name): MEGAN RICHARDSON RN, SRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN KROLIKOWSKI

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 W MCNICHOLS RD
DETROIT MI
48221-3038
US

IV. Provider business mailing address

1999 WELBECK DR
WEST BLOOMFIELD MI
48324-3951
US

V. Phone/Fax

Practice location:
  • Phone: 313-993-1245
  • Fax:
Mailing address:
  • Phone: 248-672-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704354907
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: