Healthcare Provider Details

I. General information

NPI: 1609319037
Provider Name (Legal Business Name): TREASURE RICHARDSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2016
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23333 HARVARD RD
BEACHWOOD OH
44122-6232
US

IV. Provider business mailing address

PO BOX 660
MENTOR OH
44061-0660
US

V. Phone/Fax

Practice location:
  • Phone: 440-566-0170
  • Fax:
Mailing address:
  • Phone: 440-516-3776
  • Fax: 440-854-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number428686
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number428686
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: