Healthcare Provider Details

I. General information

NPI: 1639081052
Provider Name (Legal Business Name): MARILYN RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 TOLLCROSS RD
INDIAN TRAIL NC
28079-5846
US

IV. Provider business mailing address

1340 TOLLCROSS RD
INDIAN TRAIL NC
28079-5846
US

V. Phone/Fax

Practice location:
  • Phone: 516-567-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: