Healthcare Provider Details

I. General information

NPI: 1285576983
Provider Name (Legal Business Name): RICHARD J RICHARDSON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13567 KELLER LN
WILBUR WA
99185-9752
US

IV. Provider business mailing address

13567 KELLER LN
WILBUR WA
99185-9752
US

V. Phone/Fax

Practice location:
  • Phone: 320-980-1473
  • Fax:
Mailing address:
  • Phone: 320-980-1473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN00101972
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: