Healthcare Provider Details

I. General information

NPI: 1679138507
Provider Name (Legal Business Name): CHANDRA RICHARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2137 LEAHY ST
MUSKEGON MI
49444-1124
US

IV. Provider business mailing address

2137 LEAHY ST
MUSKEGON MI
49444-1124
US

V. Phone/Fax

Practice location:
  • Phone: 231-578-0656
  • Fax:
Mailing address:
  • Phone: 231-578-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703098161
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2470A2800X
TaxonomyAssistant Health Information Record Technician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: