Healthcare Provider Details

I. General information

NPI: 1568563864
Provider Name (Legal Business Name): LYNN ANN RICHARDSON RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5637 BROOKLYN BLVD SUITE 200
BROOKLYN CENTER MN
55429-3081
US

IV. Provider business mailing address

5637 BROOKLYN BLVD SUITE 200
BROOKLYN CENTER MN
55429-3081
US

V. Phone/Fax

Practice location:
  • Phone: 763-971-2959
  • Fax: 763-971-2959
Mailing address:
  • Phone: 763-971-2959
  • Fax: 763-971-2959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR0661711
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: