Healthcare Provider Details

I. General information

NPI: 1992137517
Provider Name (Legal Business Name): ROBERT T RICHARDS CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 HIGHLANDS DR STE 100
LITITZ PA
17543-2800
US

IV. Provider business mailing address

1555 HIGHLANDS DR
LITITZ PA
17543-2800
US

V. Phone/Fax

Practice location:
  • Phone: 717-299-5000
  • Fax: 717-431-4310
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN290896L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP013113
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: