Healthcare Provider Details

I. General information

NPI: 1447900220
Provider Name (Legal Business Name): MICHELLE LORRAINE RICHARDS RN, CMGT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE LORRAINE RICHARDS RN, CMGT-BC

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 POLARIS ST
VIRGINIA BEACH VA
23461-1935
US

IV. Provider business mailing address

472 POLARIS ST
VIRGINIA BEACH VA
23461-1935
US

V. Phone/Fax

Practice location:
  • Phone: 757-981-1535
  • Fax:
Mailing address:
  • Phone: 757-981-1535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001231601
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: