Healthcare Provider Details

I. General information

NPI: 1346535606
Provider Name (Legal Business Name): LEA ANNA RICHARDSON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 23RD ST SUITE 108
OKLAHOMA CITY OK
73103-1469
US

IV. Provider business mailing address

600 NW 23RD ST SUITE 108
OKLAHOMA CITY OK
73103-1469
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-9610
  • Fax:
Mailing address:
  • Phone: 405-601-9610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR60591
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: