Healthcare Provider Details

I. General information

NPI: 1962624296
Provider Name (Legal Business Name): LAURIE A RICHARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL SUITE 12 B
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

1600 S BRENTWOOD BLVD SUITE 800
SAINT LOUIS MO
63144-1320
US

V. Phone/Fax

Practice location:
  • Phone: 314-367-1181
  • Fax: 314-968-5117
Mailing address:
  • Phone: 314-367-1181
  • Fax: 314-968-5117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: